Case report| Volume 62, P240-242, April 2019

Neuroradiological worsening of brain abscess after adalimumab and methotrexate withdrawal: Do not forget Immune Reconstitution Inflammatory Syndrome

Published:January 02, 2019DOI:


      • Immunosuppressed patients are at higher risk of brain abscess and meningitis.
      • Small abscesses on eloquent areas may be treated with medical therapy alone.
      • Close clinical and radiological monitoring is essential to guide treatment.
      • Radiological worsening may be due to Immune Reconstitution Inflammatory Syndrome.


      The incidence of brain abscess is higher among immunosuppressed patients. We report a case of a brain abscess in the temporal lobe in a patient under treatment with adalimumab and methotrexate, who developed radiological worsening. Clinical remission was essential to suspect Immune Reconstitution Inflammatory Syndrome and to continue empirical antimicrobial therapy due to the low suspicion of worsening of the abscess itself.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Clinical Neuroscience
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Brouwer M.C.
        • Tunkel A.R.
        • McKhann G.M.
        • van de Beek D.
        Brain Abscess.
        N Engl J Med. 2014; 371: 447-456
        • Brouwer M.C.
        • van de Beek D.
        Epidemiology, diagnosis, and treatment of brain abscesses.
        Curr Opin Infect Dis. 2016; 1
        • Novosad S.A.
        • Winthrop K.L.
        Beyond tumor necrosis factor inhibition: the expanding pipeline of biologic therapies for inflammatory diseases and their associated infectious sequelae.
        Clin Infect Dis. 2014; 58: 1587-1598
        • Gluck T.
        • Linde H.-J.
        • Scholmerich J.
        • et al.
        Anti-tumor necrosis factor therapy and Listeria monocytogenes infection: report of two cases.
        . Arthritis Rheum. 2002; 46: 2255-2257
        • Brook I.
        Microbiology and treatment of brain abscess.
        J Clin Neurosci. 2017; 38: 8-12
        • Tanaka T.
        • Sekine A.
        • Tsunoda Y.
        • et al.
        Central nervous system manifestations of tuberculosis-associated immune reconstitution inflammatory syndrome during Adalimumab therapy: a case report and review of the literature.
        Intern Med. 2015; 54: 847-851
        • Wallis R.S.
        Reconsidering adjuvant immunotherapy for tuberculosis.
        Clin Infect Dis. 2005; 41: 201-208
        • Jorge J.-H.
        • Graciela C.
        • Pablo A.-P.
        • Luis S.-H.J.
        A Life-Threatening central nervous system-tuberculosis inflammatory reaction nonresponsive to corticosteroids and successfully controlled by infliximab in a young patient with a variant of juvenile idiopathic arthritis.
        JCR J Clin Rheumatol. 2012; 18: 189-191
        • Blackmore T.K.
        • Manning L.
        • Taylor W.J.
        • Wallis R.S.
        Therapeutic use of infliximab in tuberculosis to control severe paradoxical reaction of the brain and lymph nodes.
        Clin Infect Dis. 2008; 47: e83-5
        • Scemla A.
        • Gerber S.
        • Duquesne A.
        • et al.
        Dramatic improvement of severe cryptococcosis-induced immune reconstitution syndrome with adalimumab in a renal transplant recipient.
        Am J Transplant. 2015; 15: 560-564