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Published on: July 9, 2014
Fatal varicella-zoster virus vasculopathy associated with adalimumab therapy
Wonki Baek1, Sang-Gon Lee, Young Seo Kim
1Department of Neurology, College of Medicine, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul 133-792, Republic of Korea.
Objective:
To describe the case of a patient who had been receiving adalimumab for rheumatoid arthritis and died of varicella-zoster virus vasculopathy with multifocal cerebral hemorrhage.
Design:
Case report.
Setting:
Hanyang University Hospital, Seoul, Republic of Korea.
Patient:
A 66-year-old woman with adalimumab therapy for rheumatoid arthritis followed by stuporous mental changes.
Results:
Magnetic resonance imaging scans showed multifocal parenchymal lesions and hemorrhage in the brainstem and supratentorial areas. Polymerase chain reaction analysis of the cerebrospinal fluid was positive for varicella-zoster virus. The patient died of multifocal vasculopathy despite intensive antiviral and antibacterial medication.
Conclusions:
Varicella-zoster virus multifocal vasculopathy with encephalitis may be associated with adalimumab therapy. Clinicians should be aware of the possibility of fatal varicella-zoster virus vasculopathy with encephalitis in patients undergoing adalimumab therapy for rheumatoid arthritis.
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