Alghazzawi Adnan, Al-Frejat Zyad, Ahmad Marie, Barkil Fadi, Shammas Lora, Darwish Enas Abood
Department of Neurology, Damascus university, Syria, Damascus, Syria.
Ann Med Surg (Lond). 2025 May 30;87(7):4661-4665. doi: 10.1097/MS9.0000000000003450. eCollection 2025 Jul.
Patients with rheumatoid arthritis who are treated with adalimumab have an increased risk of developing latent infections. The lethal risk of TB encephalitis as a potential manifestation after treatment with adalimumab should not be overlooked despite its rarity.
We report a case of a 19-year-old Middle Eastern female who developed cerebral tuberculosis after receiving adalimumab therapy for rheumatoid arthritis. The patient was systemically well. Her medical history included pneumonia, PCOs (polycystic ovary syndrome), and . Subsequently, she showed signs of anxiety after treatment with adalimumab. Magnetic resonance imaging (MRI) of the brain revealed a ring-enhancing lesion. An analysis of cerebrospinal fluid (CSF) failed to detect tuberculosis. The patient was treated and responded favorably to the tuberculosis standard four-drug anti-TB regimen (rifampicin, isoniazid, ethambutol, and pyrazinamide) and continued to show clinical improvement under ongoing treatment.
Rheumatoid arthritis patients who are treated with DMARDs are at risk of developing opportunistic infections. While most opportunistic infections are well understood and have clear symptoms, the rare occurrence of encephalitis should not be dismissed.
Although rare, TB encephalitis should be considered in patients developing neurological symptoms after treatment with Adalimumab.
接受阿达木单抗治疗的类风湿关节炎患者发生潜伏感染的风险增加。尽管结核性脑炎作为阿达木单抗治疗后潜在表现的致死风险罕见，但不应被忽视。
我们报告一例19岁中东女性病例，该患者在接受阿达木单抗治疗类风湿关节炎后发生脑结核。患者全身状况良好。她的病史包括肺炎、多囊卵巢综合征。随后，她在接受阿达木单抗治疗后出现焦虑症状。脑部磁共振成像（MRI）显示一个环形强化病灶。脑脊液（CSF）分析未检测到结核。该患者接受了治疗，并对结核标准四联抗结核方案（利福平、异烟肼、乙胺丁醇和吡嗪酰胺）反应良好，在持续治疗下持续显示临床改善。
接受改善病情抗风湿药（DMARDs）治疗的类风湿关节炎患者有发生机会性感染的风险。虽然大多数机会性感染已为人熟知且有明确症状，但脑炎的罕见发生不应被忽视。
尽管罕见，但在接受阿达木单抗治疗后出现神经症状的患者中应考虑结核性脑炎。
