Cerebral Toxoplasmosis as an Uncommon Complication of Biologic Therapy for Rheumatoid Arthritis: Case Report and Review of the Literature
Toxoplasmosis is one of the most common opportunistic infections, mainly reported in patients with acquired immunodeficiency syndrome (AIDS). Patients with rheumatoid arthritis (RA) have also been linked to reactivation of toxoplasmosis due to immunosuppressive treatment, although biologic drugs hav...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-08-01
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| Series: | Brain Sciences |
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| Online Access: | https://www.mdpi.com/2076-3425/12/8/1050 |
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| author | Gonçalo Borges de Almeida Miguel Cristóvão Carlos Pontinha Gonçalo Januário |
| author_facet | Gonçalo Borges de Almeida Miguel Cristóvão Carlos Pontinha Gonçalo Januário |
| author_sort | Gonçalo Borges de Almeida |
| collection | DOAJ |
| description | Toxoplasmosis is one of the most common opportunistic infections, mainly reported in patients with acquired immunodeficiency syndrome (AIDS). Patients with rheumatoid arthritis (RA) have also been linked to reactivation of toxoplasmosis due to immunosuppressive treatment, although biologic drugs have seldom been implicated. We present a case of cerebral toxoplasmosis in a 62-year-old female patient with RA after initiation of biologic therapy (adalimumab). The patient had detectable serum IgG antibodies to <i>toxoplasma gondii</i>, was also on chronic treatment with other non-biologic drugs and presented with worsening disorientation, unsteady gait and left hemiparesis. Imaging studies showed a space-occupying lesion in the right basal ganglia with ring-enhancement. Brain biopsy confirmed the diagnosis of toxoplasmosis and the patient was treated with pyrimethamine and sulfadiazine for 6 weeks, showing complete recovery on follow-up. A review of the literature yielded other four case reports of cerebral toxoplasmosis implying biologic drugs; however, data concerning toxoplasmosis serologic testing, prophylaxis and treatment in these patients are lacking. Each case must be carefully evaluated prior to treatment and a high-index of suspicion in seropositive patients is warranted. Since the use of biologic drugs is increasing, further research is needed to establish practical guidelines for seropositive patients receiving immunosuppressive treatment. |
| first_indexed | 2024-03-09T09:59:48Z |
| format | Article |
| id | doaj.art-be0868bb4cf540cb9f22d3de50ae391f |
| institution | Directory Open Access Journal |
| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-03-09T09:59:48Z |
| publishDate | 2022-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj.art-be0868bb4cf540cb9f22d3de50ae391f2023-12-01T23:31:09ZengMDPI AGBrain Sciences2076-34252022-08-01128105010.3390/brainsci12081050Cerebral Toxoplasmosis as an Uncommon Complication of Biologic Therapy for Rheumatoid Arthritis: Case Report and Review of the LiteratureGonçalo Borges de Almeida0Miguel Cristóvão1Carlos Pontinha2Gonçalo Januário3Department of Neuroradiology, Hospital de São José, 1150-199 Lisbon, PortugalDepartment of Pathology, Hospital de São José, 1150-199 Lisbon, PortugalDepartment of Pathology, Hospital de São José, 1150-199 Lisbon, PortugalDepartment of Neurosurgery, Hospital de São José, 1150-199 Lisbon, PortugalToxoplasmosis is one of the most common opportunistic infections, mainly reported in patients with acquired immunodeficiency syndrome (AIDS). Patients with rheumatoid arthritis (RA) have also been linked to reactivation of toxoplasmosis due to immunosuppressive treatment, although biologic drugs have seldom been implicated. We present a case of cerebral toxoplasmosis in a 62-year-old female patient with RA after initiation of biologic therapy (adalimumab). The patient had detectable serum IgG antibodies to <i>toxoplasma gondii</i>, was also on chronic treatment with other non-biologic drugs and presented with worsening disorientation, unsteady gait and left hemiparesis. Imaging studies showed a space-occupying lesion in the right basal ganglia with ring-enhancement. Brain biopsy confirmed the diagnosis of toxoplasmosis and the patient was treated with pyrimethamine and sulfadiazine for 6 weeks, showing complete recovery on follow-up. A review of the literature yielded other four case reports of cerebral toxoplasmosis implying biologic drugs; however, data concerning toxoplasmosis serologic testing, prophylaxis and treatment in these patients are lacking. Each case must be carefully evaluated prior to treatment and a high-index of suspicion in seropositive patients is warranted. Since the use of biologic drugs is increasing, further research is needed to establish practical guidelines for seropositive patients receiving immunosuppressive treatment.https://www.mdpi.com/2076-3425/12/8/1050cerebral toxoplasmosisrheumatoid arthritisbiologic therapyadalimumab |
| spellingShingle | Gonçalo Borges de Almeida Miguel Cristóvão Carlos Pontinha Gonçalo Januário Cerebral Toxoplasmosis as an Uncommon Complication of Biologic Therapy for Rheumatoid Arthritis: Case Report and Review of the Literature Brain Sciences cerebral toxoplasmosis rheumatoid arthritis biologic therapy adalimumab |
| title | Cerebral Toxoplasmosis as an Uncommon Complication of Biologic Therapy for Rheumatoid Arthritis: Case Report and Review of the Literature |
| title_full | Cerebral Toxoplasmosis as an Uncommon Complication of Biologic Therapy for Rheumatoid Arthritis: Case Report and Review of the Literature |
| title_fullStr | Cerebral Toxoplasmosis as an Uncommon Complication of Biologic Therapy for Rheumatoid Arthritis: Case Report and Review of the Literature |
| title_full_unstemmed | Cerebral Toxoplasmosis as an Uncommon Complication of Biologic Therapy for Rheumatoid Arthritis: Case Report and Review of the Literature |
| title_short | Cerebral Toxoplasmosis as an Uncommon Complication of Biologic Therapy for Rheumatoid Arthritis: Case Report and Review of the Literature |
| title_sort | cerebral toxoplasmosis as an uncommon complication of biologic therapy for rheumatoid arthritis case report and review of the literature |
| topic | cerebral toxoplasmosis rheumatoid arthritis biologic therapy adalimumab |
| url | https://www.mdpi.com/2076-3425/12/8/1050 |
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