Brain abscess in a patient with psoriatic arthritis treated with adalimumab

Abstract

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.

Prostatic Abscesses in a Patient Receiving Tumor Necrosis Factor-Alpha Inhibitor Therapy for Hidradenitis Suppurativa: A Case Report

“…Even though there is no definitive proof of direct causality between the intake of adalimumab and the occurrence of abscess-forming prostatitis in this case, TNF-α most probably played a role in this case. The causality is supported by two other case reports of abscess-forming diseases under therapy with TNF-α inhibitors [12,13].…”

P. micra and F. necrophorum: Hepatic Abscesses in a Healthy Soldier

“…Based on literature review, coinfection of Parvimonas and Fusobacterium appears to be extremely rare. One reported case involved a 39-year-old male with psoriatic arthritis who had recently initiated immunosuppressive therapy and presented with new-onset seizures [ 16 ]. He was subsequently found to have a brain abscess, which when cultured grew P. micra , F. nucleatum , and S. sanguinis [ 16 ].…”

“…One reported case involved a 39-year-old male with psoriatic arthritis who had recently initiated immunosuppressive therapy and presented with new-onset seizures [ 16 ]. He was subsequently found to have a brain abscess, which when cultured grew P. micra , F. nucleatum , and S. sanguinis [ 16 ]. It was later discovered he had undiagnosed periodontal disease prior to starting immunosuppressive therapy, thought to be the origin of his infection [ 16 ].…”

“…He was subsequently found to have a brain abscess, which when cultured grew P. micra , F. nucleatum , and S. sanguinis [ 16 ]. It was later discovered he had undiagnosed periodontal disease prior to starting immunosuppressive therapy, thought to be the origin of his infection [ 16 ]. The second reported case involved a 72-year-old female with metastatic breast cancer, vertebral metastasis, and destructive spondylodiscitis with intraspinal abscess [ 17 ].…”

“…Her abscess culture grew P. micra and F. nucleatum [ 17 ]. In both cases, abscess drainage and antibiotic therapy successfully resolved the infection [ 16 , 17 ].…”