Central Nervous System Manifestations of Tuberculosis-associated Immune Reconstitution Inflammatory Syndrome during Adalimumab Therapy: A Case Report and Review of the Literature

Toru Tanaka; Akimasa Sekine; Yoshiya Tsunoda; Hiroyuki Takoi; Shin-Yuan Lin; Yohei Yatagai; Kenji Hayasihara; Takefumi Saito

doi:10.2169/internalmedicine.54.2828

CASE REPORTS

Central Nervous System Manifestations of Tuberculosis-associated Immune Reconstitution Inflammatory Syndrome during Adalimumab Therapy: A Case Report and Review of the Literature

Toru Tanaka, Akimasa Sekine, Yoshiya Tsunoda, Hiroyuki Takoi, Shin-Yuan Lin, Yohei Yatagai, Kenji Hayasihara, Takefumi Saito

Author information

Toru Tanaka
Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Japan
Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
Akimasa Sekine
Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Japan
Yoshiya Tsunoda
Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Japan
Hiroyuki Takoi
Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Japan
Shin-Yuan Lin
Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Japan
Yohei Yatagai
Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Japan
Kenji Hayasihara
Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Japan
Takefumi Saito
Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Japan

Keywords: adalimumab, anti-TNF therapy, tuberculosis, central nervous system tuberculosis, immune reconstitution inflammatory syndrome

JOURNAL OPEN ACCESS

2015 Volume 54 Issue 7 Pages 847-851

DOI https://doi.org/10.2169/internalmedicine.54.2828

Details

Abstract

A 64-year-old neurologically asymptomatic woman with rheumatoid arthritis who was treated with the tumor necrosis factor (TNF)-α antagonist adalimumab developed disseminated tuberculosis (TB). After receiving anti-TB therapy and discontinuing adalimumab, she exhibited paradoxical worsening due to immune reconstitution inflammatory syndrome (IRIS) with the appearance of meningitis and brain tuberculomas. This case indicates that continuing anti-TNF therapy may be necessary to prevent IRIS in patients who develop TB, particularly disseminated TB, during the course of anti-TNF therapy. In addition, careful screening for central nervous system (CNS) TB should be performed prior to the initiation of therapy, as even neurologically asymptomatic patients can develop CNS manifestations of IRIS.

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