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Cerebral tuberculoma in a patient receiving anti-TNF alpha (adalimumab) treatment

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Abstract

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.

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Fig. 1
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Abbreviations

CDC:

Centers for Disease Control

TNF:

Tumor necrosis factor

ZN:

Ziehl Nielson

GFAP:

Glial fibrillary acidic protein

PPD:

Purified protein derivative

RA:

Rheumatoid arthritis

DMARDs:

Disease-modifying anti-rheumatic drugs

LTBI:

Latent tuberculous bacilli infection

IGRA:

Interferon-gamma release assay.

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Disclosures

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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Authors and Affiliations

  1. Department of Neuropathology, Beaumont Hospital, Beaumont, Dublin 9, Ireland

    Karen Lynch & Michael Farrell

  2. Department of Neurology Tufts University, St Elizabeth’s Medical Center, 736 Cambridge Street, Boston, MA, 02135, USA

    Karen Lynch

Authors
  1. Karen Lynch
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  2. Michael Farrell
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Correspondence to Karen Lynch.

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Lynch, K., Farrell, M. Cerebral tuberculoma in a patient receiving anti-TNF alpha (adalimumab) treatment. Clin Rheumatol 29, 1201–1204 (2010). https://doi.org/10.1007/s10067-010-1466-7

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  • DOI: https://doi.org/10.1007/s10067-010-1466-7

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