Sinogenic intracranial complications: is adalimumab a culprit?

Kofoed, Mikkel Seremet; Fisker, Niels; Christensen, Anne Estmann; Kjeldsen, Anette Drøhse

doi:10.1136/bcr-2017-221449

Cited by 4 publications

(2 citation statements)

References 27 publications

(16 reference statements)

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“…[ 10 ] Seemingly, infections develop more rapidly in the CNS than other systems; however, it cannot be concluded because only three cases have been documented in the literature to date. [ 10 – 12 ] Our patient developed DRESS syndrome while receiving antibiotics. Furthermore, adalimumab has been reported as one of the factors inducing DRESS syndrome along with vancomycin.…”

Section: Discussionmentioning

confidence: 94%

Brain abscess in a patient with psoriatic arthritis treated with adalimumab

Desale

2020

Medicine

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Rationale: In patients receiving biological therapies, serious infections are a major concern. Infections associated with anti-tumor necrosis factor antibody therapy include tuberculosis, viral, fungal, and bacterial infections. Likewise, severe infections of the upper and lower respiratory tract, lung, skin and soft tissue, urinary tract, gastrointestinal tract, joint, and bone have also been reported previously. However, infections involving the central nervous system are rare, especially an intracranial infection caused by odontogenic infection. To date, only few cases have been reported of this infection. This is the first case of a patient with psoriatic arthritis receiving adalimumab and developing brain abscess of odontogenic origin. Patient concerns: A 39-year-old male with psoriatic arthritis receiving adalimumab treatment came to the emergency department with initial presentation of sudden onset convulsions. He had been receiving adalimumab treatment for 1 month. Two days after the third injection, the patient had an episode of sudden-onset general convulsion for nearly 5 min with the upgazing and general tonic presentation. Magnetic resonance imaging (MRI) showed left frontal lobe brain abscess. Pus culture from the brain abscess detected Streptococcus sanguinis ( S. sanguinis ), Fusobacterium nucleatum ( F. nucleatum ), and Parvimonas micra ( P. micra ). Diagnosis: Brain abscess with odontogenic infection. Interventions: The patient received left frontal craniotomy, abscess drainage and systemic empiric antibiotics treatment with vancomycin, cefepime, and metronidazole. Due to drug rash with eosinophilia and systemic symptoms during the treatment, vancomycin and metronidazole were discontinued, and systemic antibiotics were switched to teicoplanin and ceftriaxone. Outcomes: A brain MRI follow-up performed after 1 month of initial treatment revealed the reduced size of the abscess lesion and minimal oedema. The patient was discharged with stable condition. Lessons: To the best of our knowledge, this is the first case of a patient with psoriatic arthritis receiving adalimumab and developing brain abscess of odontogenic origin. Such a rare diagnosis must be kept in mind when patients treated with adalimumab present with sudden-onset convulsions. Careful dental examination should be performed before administration of adalimumab.

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Section: Discussionmentioning

confidence: 94%

Brain abscess in a patient with psoriatic arthritis treated with adalimumab

Desale

2020

Medicine

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“…She made a complete recovery after antibiotic therapy. There is also a report of an 11-year-old girl treated for chronic recurrent multifocal osteomyelitis with adalimumab who then developed acute sinusitis complicated by an orbital abscess and subdural empyema 64. She underwent rhinosurgery and neurosurgery with intravenous antibiotics and had no long-term neurological sequelae.…”

Section: Resultsmentioning

confidence: 99%

Ocular side effects of antirheumatic medications: a qualitative review

et al. 2020

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TopicThis paper reviews the ocular side effects of medications used in the treatment of rheumatological conditions.Clinical relevanceRheumatic diseases are inflammatory conditions that may affect the skin, blood vessels, joints, muscles and internal organs. Immunosuppressive agents are often used as treatment and while powerful, they carry side effects and toxicities that need careful monitoring. Ophthalmic complications have been reported with the use of antirheumatic medications; however, there is a lack of literature synthesising these reports. This paper addresses this gap and hopes to inform both rheumatologists and ophthalmologists as they work together on the management of patients with rheumatological conditions.MethodsPubMed literature search was conducted from November to September 2019 searching for ocular side effects with the use of 25 rheumatological drugs.ResultsA total of 111 papers were included in this review. Adverse side effects were divided into non-infectious and infectious causes. Traditional disease-modifying antirheumatic drugs (DMARDs) were associated with pruritus, irritation and dryness of the conjunctiva while biologic DMARDS showed reports of new-onset/recurrent uveitis and demyelinating conditions. Infectious side effects included episodes of cytomegalovirus retinitis, toxoplasmic chorioretinitis and endophthalmitis. Other serious side effects were encountered and included in this review.ConclusionThe goal of this paper is to inform healthcare providers about potential ocular side effects from rheumatological medications. Healthcare providers are encouraged to learn more about these ophthalmic complications and find relevance within their clinical practice.

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Adalimumab

2018

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Sinogenic intracranial complications: is adalimumab a culprit?

Cited by 4 publications

References 27 publications

Brain abscess in a patient with psoriatic arthritis treated with adalimumab

Brain abscess in a patient with psoriatic arthritis treated with adalimumab

Ocular side effects of antirheumatic medications: a qualitative review

Adalimumab

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