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Published on: May 7, 2020
Intractable pneumococcal meningoencephalitis associated with a TNF-α antagonist
Seok-Jae Kang1, Hyun Young Kim1, Young Seo Kim1
1Departments of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
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.
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