Adalimumab
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Miliary tuberculosis and inflammatory process of the CNS: 2 case reports In a case series involving 2 patients (a girl aged 7 years and a boy aged 14 years) were described, who developed miliary tuberculosis (the girl) or an inflammatory process of the CNS with serious neurological deficits (the boy) during treatment with adalimumab for juvenile idiopathic arthritis [JIA; routes and dosages not stated]. Case 1: The girl was diagnosed with juvenile idiopathic arthritis (JIA) at age of 2 years. Initial treatment included unspecified NSAIDs with methotrexate and intra-articular occasional injections of corticosteroids. By the age of 4 years, she developed uveitis as a complication of the JIA. Therefore, she received treatment with unspecified systemic corticosteroids and methotrexate along with topical ophthalmologic therapy (that included unspecified corticosteroids, NSAIDs and mydriatic eye-drops). However, as no improvement was noted in her condition, her treatment was started with etanercept. Prior to the initiation of etanercept therapy, tuberculin skin test and interferon-gamma tests were performed which showed negative results. The articular component of her disease responded well to therapy; however, bilateral chronic uveitis continued to progress. Therefore, after one year of treatment, her etanercept therapy was changed to adalimumab. Repeat tuberculin skin test and interferon-gamma tests were performed prior to the start of adalimumab therapy, which showed negative results. With the adalimumab therapy, improvement was noted in her condition, and she achieved remission of the uveitis. After 20 moths of treatment, she presented to hospital due to prolonged sub0-febrile temperatures, loss of appetite, cough and running nose. Following hospitalisation, she developed fever with body temperature of 39°C and her cough progressed. Laboratory tests showed a rise in ESR (43 mm/h) and CRP (60.3 mg/L). Chest-CT demonstrated multiple small nodules diffusely spread over both lungs leading to the suspicion of miliary tuberculosis. Sputum test for Mycobacterium tuberculosis was negative, but QuantiFERON test and PCR test showed positive results for Mycobacterium tuberculosis. During anamnesis, it was revealed that her family has moved to live with relative one of whom was treated for tuberculosis. Consequently, her treatment was started with unspecified multidrug anti-tuberculosis therapy, and both ongoing methotrexate and adalimumab therapies were stopped. The anti-tuberculosis therapy was continued for 9 months and resulted in a complete recovery. Four months after discontinuation of adalimumab and methotrexate, she developed flare of uveitis followed by a flare of JIA after 3 months. Her treatment was started with unspecified corticosteroids and methotrexate. At the time of last followup examination, her uveitis was noted to be in remission, and unspecified corticosteroids and methotrexate were ongoing. Case 2: The boy was diagnosed with juvenile idiopathic arthritis (JIA) at the age of 4 years. Later, he also deve
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