Reactivation of cereberal tuberculosis post-adalimumab therapy for rheumatoid arthritis: a case report

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 H. pylori gastritis. 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.