CNS TB-IRIS Following Cessation of Adalimumab in an Adolescent With Crohn’s Disease

Abstract

Immune reconstitution inflammatory syndrome to tuberculosis (TB-IRIS) is an inflammatory response to M. tuberculosis infection that arises following restoration of the immune system and is increasingly recognized as a risk in patients treated with TNF-α inhibitors who develop active tuberculosis infection. We present the case of a 19 year old man treated with adalimumab for Crohn’s disease, who presented with disseminated miliary tuberculosis. His treatment course was complicated by central nervous system (CNS) TB-IRIS following cessation of his immunosuppression. We review the presentation and differential diagnosis of TB-IRIS, as well as risk factors for developing IRIS and the treatment of IRIS in this population.