College of Medicine, Gulf Medical University, Ajman.
Pathology Department, Cleveland Clinic Abu Dhabi, Abu Dhabi.
World Neurosurg. 2020 Jul;139:260-263. doi: 10.1016/j.wneu.2020.03.155. Epub 2020 Apr 2.
Adalimumab (Humira) is a recombinant human monoclonal antibody against tumor necrosis factor alpha, which works by blocking the interaction of tumor necrosis factor alpha with its cell-surface receptors, thereby limiting the progression of inflammatory pathways. Its use is approved for several autoimmune conditions, including chronic plaque psoriasis, for which it has been prescribed as a first-line biologic treatment. Increased risks of malignancy, particularly nonmelanoma skin cancer and non-central nervous system lymphomas, have been reported with use of this drug; however, there have been no reports of central nervous system lymphomas.
A 43-year-old man presented for evaluation following recent speech difficulty and a generalized tonic-clonic seizure. His medical history was significant for plaque psoriasis, for which he had been receiving treatment with adalimumab for 4 months. Magnetic resonance imaging scan of the brain with contrast agent showed a well-defined rounded enhancing lesion in the left temporal lobe with circumferential vasogenic edema. Mass effect was noted. Computed tomography scan of the chest, abdomen, and pelvis was unremarkable. He underwent excisional biopsy, and the preliminary intraoperative pathology report revealed a diagnosis of high-grade lymphoma. Subsequent analysis of morphology and immunophenotyping was consistent with primary diffuse large B-cell lymphoma of the central nervous system. Use of adalimumab was discontinued. Following combination therapy with high-dose methotrexate and rituximab along with 20 sessions of cranial radiation therapy, the patient was disease-free at 14-month follow-up.
We report the first case to our knowledge showing a possible association of central nervous lymphoma and adalimumab.
阿达木单抗（修美乐）是一种针对肿瘤坏死因子 α 的重组人单克隆抗体，通过阻断肿瘤坏死因子 α 与其细胞表面受体的相互作用，从而限制炎症途径的进展。其用途已获批准用于多种自身免疫性疾病，包括慢性斑块型银屑病，该药已被规定为一线生物治疗药物。使用这种药物已报告了恶性肿瘤风险增加，特别是非黑色素瘤皮肤癌和非中枢神经系统淋巴瘤；然而，尚未有中枢神经系统淋巴瘤的报告。
一名 43 岁男性因近期言语困难和全身强直阵挛性发作就诊。他的病史显著为斑块型银屑病，为此他接受阿达木单抗治疗已有 4 个月。脑增强磁共振成像扫描显示左侧颞叶有一个界限清楚的圆形强化病变，伴有环形血管源性水肿。有肿块效应。胸部、腹部和骨盆的计算机断层扫描无明显异常。他接受了切除活检，初步术中病理报告显示高级别淋巴瘤的诊断。随后的形态学和免疫表型分析与原发性中枢神经系统弥漫性大 B 细胞淋巴瘤一致。阿达木单抗的使用已停止。在接受高剂量甲氨蝶呤和利妥昔单抗联合 20 次颅部放射治疗的联合治疗后，患者在 14 个月的随访时无疾病。
我们报告了首例据我们所知显示中枢神经系统淋巴瘤和阿达木单抗之间可能存在关联的病例。
