Cerebral tuberculoma in a patient receiving anti-TNF alpha (adalimumab) treatment
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We report a case of a cerebral tuberculoma in a 60-year-old woman with rheumatoid arthritis while receiving the anti-tumor necrosis factor alpha monoclonal antibody, adalimumab (Humira), for active disease. MR brain imaging for dyspraxia revealed a left parietal ring-enhancing lesion, which on resection was shown to be a necrotizing granuloma. There were no associated pulmonary lesions, and the patient was systemically well. Sputum and urine cultures were negative for tuberculosis. The patient was treated with anti-tuberculous medications and made an excellent recovery. We consider this to be the first documented case of tuberculosis involving the central nervous system occurring in the setting of adalimumab treatment.
KeywordsAdalimumab Anti-TNF Cerebral Rheumatoid arthritis. Tuberculoma
Centers for Disease Control
Tumor necrosis factor
Glial fibrillary acidic protein
Purified protein derivative
Disease-modifying anti-rheumatic drugs
Latent tuberculous bacilli infection
Interferon-gamma release assay.
The following case report is authored by Karen Lynch MD and Michael Farrell MD. It adheres to ethical guidelines and standards, and there was no financial or other conflict of interests associated with this case or the authors.
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