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Author | Anti-TNF agent used | Underlying disease | Clinical presentation | Imaging findings | Cerebrospinal (CSF) findings | Pathological findings | Outcome |
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Berrios et al. [15] | Etanercept | Chronic JRA and refractory uveitis | Acute mental status change, fever, headache, joint pain, dizziness, night sweats, chills | First brain MRI: diffuse abnormal hyper intensities within sulci of both cerebral hemispheres associated with abnormal leptomeningeal enhancement, 2 small nonspecific foci of fluid-attenuated inversion recovery hyperintense signals in the right thalamus and lower pons. Second brain MRI: small hyperintense cortical lesions. Cervical spine MRI: incidental abnormal lymph nodes in the right upper mediastinum. CT thorax, abdomen and pelvis: hepatosplenomegaly, lymphadenopathy in the axillary, mediastinal, intra-abdominal, iliac chain and inguinal lymph nodes. PET scan: unremarkable. | 96% lymphocytes, 3% monocytes, 1% lymphocytes, protein: 48 mg/dl, glucose: 49 mg/dl. | Noncaseating granulomatous lymphadenitis | Clinical and imaging improvement. |
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Sturfelt et al. [16] | Infliximab, methotrexate | Erosive RA | Headache, fever, diplopia, severe papilledema of both eyes, nerve palsy of the left eye | Head CT, brain and spinal cord MRI, MR angiography: unremarkable. Transcranial Doppler analysis: high intracranial pressure. | Slight pleocytosis with mononuclear leucocytes of 49 × 106/l and polynuclear leucocytes 4 × 106/l, normal CSF/blood glucose ratio, slightly increased protein of 0.78 g/l. Negative culture results for bacteria, viral, fungal or protozoan infection. | Bilateral granulomatous iridocyclitis, retinal periphlebitis | Resolution of headache, papilledema, eye muscle function. Pathological ophthalmic changes slowly subsided. Symptoms. Returned to work full-time. |
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Durel et al. [17] | Etanercept | Erosive RA | Bilateral facial paralysis, anosmia, papilledema, anterior uveitis, weight loss, dyspnea, sicca symptoms | Brain MRI: enhanced signal of cranial nerves. Chest CT: bilateral hilar and mediastinal lymph nodes. | Elevated protein, normal glucose without oligoclonal bands. | No histological confirmation | Complete resolution of eye sight and brain MRI findings but not facial paralysis. |
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Mao-Draayer et al. [18] | Adalimumab | HLA-B27-positive AS | New seizures | Head CT: hypo density in left frontal subcortical white matter. Brain MRI: leptomeningeal enhancement and several hyperintense lesions. | Mild lymphocytic leukocytosis, elevated protein. | Noncaseating granuloma | Resolution of the disease. |
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