Demyelinating central nervous system lesions , following the use of tumor necrosis factor alpha antagonist

Content Provider	Semantic Scholar
Author	Markoula, Sofia Zikou, A. Voulgari, Paraskevi V. Drosos, Aleksandros
Copyright Year	2018
Abstract	Tumor necrosis factor alpha (TNFα) antagonists have been a valuable tool in treating patients with rheumatoid arthritis (RA), but reports and case series of neurological adverse events due to TNFα antagonists have been reported. Furthermore, central nervous system (CNS) lymphoma always remains a remote, yet a worrisome complication in RA patients, especially in those under treatment with methotrexate (MTX). We present a female patient with RA with tumor-like active demyelinating lesions attributed to TNFα antagonist, confirmed by an FNA biopsy, otherwise clinically and radiologically challenging to distinguish from CNS lymphoma. A 72-year-old female patient with RA under TNFα antagonist and MTX treatment was presented with neurological symptoms and signs. The brain MRI revealed four tumor-like contrast-enhancing lesions bilaterally, the demyelinating nature of which was delineated by the FNA biopsy. A full clinical and radiological recovery was achieved after the TNFα antagonist was permanently withdrawn. Patients with RA under anti-TNF agents and MTX are predisposed to complications such as CNS lymphoma and CNS demyelination. This case uniquely highlights the physicians’ vigilance in pursuing these complications and the usage of the FNA when tumor-like appearances on the brain MRI convolute the final diagnosis.
File Format	PDF HTM / HTML
Alternate Webpage(s)	http://nnjournal.net/article/showpdf/2550/2100
Language	English
Access Restriction	Open
Subject Keyword	Adverse reaction to drug Biomarkers, Tumor CNS disorder Demyelinating Autoimmune Diseases, CNS Demyelination Lymphoma, Non-Hodgkin Methotrexate Neoplasms Neurologic Symptoms Patients Rheumatoid Arthritis Traffic collision avoidance system childhood central nervous system germ cell tumor cns lymphoma tumor necrosis
Content Type	Text
Resource Type	Article