Primary Central Nervous System Lymphoma in a Patient on Adalimumab Therapy for Chronic Plaque Psoriasis

Farah, Riyaq Abdi; Alduaij, Ahmad; Ugas, Carlos; Navarro, R. Pérez

doi:10.1016/j.wneu.2020.03.155

Cited by 6 publications

(5 citation statements)

References 10 publications

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“…2 ), which are imaging characteristics consistent with a highly cellular mass that could represent a metastasis, PCNSL, or high-grade glioma. The patient had previously been receiving methotrexate and adalimumab therapy for RA, and both drugs have been associated with development of PCNSL, 8 , 9 which furthered our suspicion. However, the possibility of metastasis from a primary MCC lesion was high on the differential diagnosis, and surgery was recommended.…”

Section: Illustrative Casementioning

confidence: 71%

“…MCC brain metastasis have been reported to radiographically mimic sellar lesions, meningioma, CNS high grade glioma, and primary CNS lymphoma as in this case presented. PCNSL occurs in the in the frontal lobe 20%-43% of the time, 22 and there are case reports of patients who were receiving methotrexate and adalimumab who developed PCNSL, 8,9 which made suspicion of PCNSL high on the differential diagnosis in our case because the patient had been receiving these medications before her MCC diagnosis. PCNSL characteristically enhances on postcontrast T1-weighted imaging with T2 hyperintensity secondary to high cellularity and surrounding vasogenic edema.…”

Section: Diagnostic Algorithm For MCC Metastasismentioning

confidence: 77%

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Merkel cell carcinoma brain metastasis with radiological findings mimicking primary CNS lymphoma: illustrative case

Schreiber²,

Garg

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor with a high likelihood of distant metastasis. Approximately 30 cases of MCC brain metastasis have been reported. The authors report a case of MCC brain metastasis with imaging findings mimicking primary central nervous system lymphoma. OBSERVATIONS A 69-year-old asymptomatic White female with a past medical history of rheumatoid arthritis and MCC of the right cheek with no known regional or distant spread presented with a right frontal lobe lesion discovered incidentally on a surveillance scan. Brain magnetic resonance imaging revealed a vividly enhancing homogeneous lesion with restricted diffusion on diffusion-weighted imaging and corresponding apparent diffusion coefficient maps. Imaging characteristics suggested a highly cellular mass consistent with primary central nervous system lymphoma; however, given the likelihood of metastasis, resection was recommended. An intraoperative frozen section suggested lymphoma. However, further examination revealed positive cytokeratin 20 staining for a tumor, and a final diagnosis of MCC brain metastasis was made. LESSONS Imaging characteristics of MCC brain metastasis can vary widely. A high level of suspicion should be maintained in a patient with a known history of MCC. Aggressive resection is recommended, regardless of appearance on scans or pathology of frozen sections, because MCC can mimic other intracranial pathologies.

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Section: Illustrative Casementioning

confidence: 71%

Section: Diagnostic Algorithm For MCC Metastasismentioning

confidence: 77%

Merkel cell carcinoma brain metastasis with radiological findings mimicking primary CNS lymphoma: illustrative case

Schreiber²,

Garg

et al. 2022

Journal of Neurosurgery: Case Lessons

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“…Most reports of PCNSL describe MTX-LPD due to low-dose MTX therapy, 14 and there is also a report of a case of PCNSL during treatment with adalimumab, an IL-6 inhibitor, although that was a case of psoriasis vulgaris rather than RA. 15 Tocilizumab might affect tumor immunity through inhibition of the IL-6 signaling pathway. IL-6 is an inflammatory cytokine involved in the local and systemic manifestations of RA.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Primary central nervous system malignant lymphoma in a patient with rheumatoid arthritis receiving tocilizumab: illustrative case

Ohno

Kuramitsu²,

Iwakoshi

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Although the risk of developing malignant lymphoma is higher in patients with rheumatoid arthritis (RA) than in the general population, primary central nervous system lymphoma (PCNSL) in patients with RA is extremely rare. In recent years, there has been concern that biological disease-modifying antirheumatic drugs (bDMARDs), widely administered to patients with RA, might increase the risk of cancer development. The authors report the first case of PCNSL in a patient with RA receiving the bDMARD tocilizumab. OBSERVATIONS A 70-year-old man who was diagnosed with RA in 2010 was treated with low-dose methotrexate (MTX) from 2010 to 2015. Tocilizumab was commenced in 2012. In 2018, he developed gait disturbances, and gadolinium-enhanced magnetic resonance imaging showed multiple contrast-enhanced lesions in the basal ganglia and brain stem. Stereotactic brain biopsy led to the diagnosis of diffuse large B-cell lymphoma, and finally PCNSL was diagnosed. He was treated with five courses of MTX 3.5 g/m2, and his disease has been in remission for 34 months. LESSONS Low-dose MTX and bDMARDs are associated with the concern of increased cancer risk in patients with RA. Because tocilizumab has been in use for a relatively short time, further accumulation of cases and careful follow-up are necessary.

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“…An increase of developing all cancers has been found in patients with psoriasis treated with adalimumab and infliximab compared with the general population in a pooled analysis of 71 controlled trials (OR 3.3; CI 1.2-9.1) [209]. The association between tumorigenesis and anti-TNF therapy was also documented in multiple case reports [210][211][212]. In contrast, based on the data of two meta-analyses and one observational study, TNF inhibitors did not meet the statistical significance in increasing the risk of malignancy [213][214][215].…”

Section: Tnf-α Inhibitorsmentioning

confidence: 99%

Biologic and Small-Molecule Therapies for Moderate-to-Severe Psoriasis: Focus on Psoriasis Comorbidities

Jiang

Chen

et al. 2023

BioDrugs

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Psoriasis is a systemic immune-mediated disease associated with an increased risk of comorbidities, such as psoriatic arthritis, cardiovascular disease, metabolic syndrome, inflammatory bowel disease, psychiatric disorders, and malignancy. In recent years, with the advent of biological agents, the efficacy and safety of psoriasis treatments have dramatically improved. Presently, tumor necrosis factor-α inhibitors, interleukin-17 inhibitors, interleukin-12/23 inhibitors, and interleukin-23 inhibitors are approved to treat moderate-to-severe psoriasis. Small-molecule inhibitors, such as apremilast and deucravacitinib, are also approved for the treatment of psoriasis. Although it is still unclear, systemic agents used to treat psoriasis also have a significant impact on its comorbidities by altering the systemic inflammatory state. Data from clinical trials and studies on the safety and efficacy of biologics and small-molecule inhibitors provide important information for the personalized care and treatment for patients with psoriasis. Notably, treatment with interleukin-17 inhibitors is associated with new-onset or exacerbations of inflammatory bowel disease. In addition, great caution needs to be taken when using tumor necrosis factor-α inhibitors in patients with psoriasis with concomitant congestive heart failure, multiple sclerosis, and malignancy. Apremilast may induce weight loss as an adverse effect, presenting also with some beneficial metabolic actions. A better understanding of the characteristics of biologics and small-molecule inhibitors in the treatment of psoriasis comorbidities can provide more definitive guidance for patients with distinct comorbidities.

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Primary Central Nervous System Lymphoma in a Patient on Adalimumab Therapy for Chronic Plaque Psoriasis

Cited by 6 publications

References 10 publications

Merkel cell carcinoma brain metastasis with radiological findings mimicking primary CNS lymphoma: illustrative case

Merkel cell carcinoma brain metastasis with radiological findings mimicking primary CNS lymphoma: illustrative case

Primary central nervous system malignant lymphoma in a patient with rheumatoid arthritis receiving tocilizumab: illustrative case

Biologic and Small-Molecule Therapies for Moderate-to-Severe Psoriasis: Focus on Psoriasis Comorbidities

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