Intractable pneumococcal meningoencephalitis associated with a TNF-α antagonist

Related Experiment Video

Updated: Apr 27, 2026

Induction of Leptomeningeal Cells Modification Via Intracisternal Injection
05:55

Induction of Leptomeningeal Cells Modification Via Intracisternal Injection

Published on: May 7, 2020

7.9K

Seok-Jae Kang1, Hyun Young Kim1, Young Seo Kim1

  • 1Departments of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea.

Journal of the Neurological Sciences
|July 8, 2014
PubMed

Insights

Tumor necrosis factor-alpha (TNF-α) antagonists may increase the risk of fatal pneumococcal meningoencephalitis. This case highlights the potential for unusual bacterial meningitis presentations in patients on these therapies.

Area of Science:

  • Neuroscience
  • Immunology
  • Infectious Diseases

Background:

  • Ankylosing spondylitis is a chronic inflammatory disease often treated with TNF-α antagonists.
  • TNF-α antagonists modulate the immune system, potentially increasing susceptibility to infections.

Observation:

  • A patient on TNF-α antagonist therapy for ankylosing spondylitis developed a central nervous system infection.
  • Cerebrospinal fluid and blood cultures identified Streptococcus pneumoniae.
  • MRI revealed diffuse subcortical white matter lesions.

Findings:

  • The patient succumbed to multifocal brain damage and subarachnoid hemorrhage despite treatment.
  • This case demonstrates pneumococcal meningoencephalitis occurring in the context of TNF-α antagonist use.

Implications:

  • Clinicians must recognize the heightened risk of severe bacterial meningoencephalitis in patients receiving TNF-α antagonists.
  • Awareness of atypical bacterial meningitis presentations is crucial for timely diagnosis and management.
Keywords:
Bacterial meningitisInfliximabMeningoencephalitisStreptococcus pneumoniaeTNF-α antagonistWhite matter

More Related Videos

Determination of the Relative Potency of an Anti-TNF Monoclonal Antibody mAb by Neutralizing TNF Using an In Vitro Bioanalytical Method16:07

Determination of the Relative Potency of an Anti-TNF Monoclonal Antibody mAb by Neutralizing TNF Using an In Vitro Bioanalytical Method

Published on: September 16, 2017

8.2K
Development of an Insert Co-culture System of Two Cellular Types in the Absence of Cell-Cell Contact11:29

Development of an Insert Co-culture System of Two Cellular Types in the Absence of Cell-Cell Contact

Published on: July 17, 2016

27.7K

Related Concept Videos

Bacterial Meningitis I: Introduction01:22

Bacterial Meningitis I: Introduction

Bacterial meningitis is a severe, life-threatening inflammation of the meninges, particularly the pia mater and arachnoid mater, affecting the subarachnoid space, ventricles, and cerebrospinal fluid (CSF). If untreated, it can lead to significant neurological complications or death.Causative AgentsCommon pathogens vary with age and immune status. In adults, major organisms include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Streptococcus agalactiae (group B...
9
Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF01:24

Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF

Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
872
Bacterial Meningitis II: Pathophysiology01:26

Bacterial Meningitis II: Pathophysiology

Bacterial meningitis typically begins when pathogens such as Neisseria meningitidis and Streptococcus pneumoniae colonize the nasopharynx and invade the bloodstream. This process is facilitated by bacterial virulence factors, such as polysaccharide capsules, which resist phagocytosis and complement-mediated killing. Less commonly, bacteria reach the central nervous system via contiguous spread from infections like otitis media or sinusitis, through congenital or acquired dural defects, or...
10
Atypical Pneumonia01:14

Atypical Pneumonia

Atypical pneumonia, often caused by Mycoplasma pneumoniae, is a form of pulmonary infection that differs from the classical presentation of bacterial pneumonia in both its cause and clinical symptoms. Mycoplasma pneumoniae is a pleomorphic bacterium notable for its lack of a rigid cell wall. This structural characteristic imparts resistance to beta-lactam antibiotics and significantly influences the bacterium’s behavior within the human host.Other pathogens responsible for the disease...
79
Encephalitis l: Introduction01:19

Encephalitis l: Introduction

Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...
10
Pneumonia IV: Management01:28

Pneumonia IV: Management

The treatment of pneumonia varies based on its severity and the causative pathogen. Here is a structured approach to managing pneumonia, integrating pharmaceutical and supportive care strategies.
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
1.2K