Adalimumab
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Primary diffuse large B-cell lymphoma of the central nervous system: case report A 43-year-old man developed primary diffuse large B-cell lymphoma of the central nervous system during treatent with adalimumab for chronic plaque psoriasis. The man presented with speech difficulty and a generalised tonic-clonic seizure. His had a significant medical medical of hypertension and chronic plaque psoriasis, for which he had been receiving SC adalimumab injection [dosage not stated] for approximately 4 months. He was admitted. Brain MRI showed a well-defined rounded enhancing lesion in the left temporal lobe, with circumferential vasogenic oedema. Mass effect was also noted, with slight anterior displacement of the left temporal horn. MRI spectroscopy showed decreased N-acetyl aspartate peak. MRI brain perfusion sequences revealed elevated blood volume in the lesion. CT scans of the chest, abdomen and pelvis were unremarkable. At this stage, the differential diagnosis was neoplastic process or an opportunistic infection. He was then scheduled for an excisional biopsy. The man underwent a small left temporal craniotomy with image guidance. It was observed that macroscopic complete resection of the lesion could be obtained. A preliminary intraoperative pathology report indicated a diagnosis of high-grade lymphoma. A complete resection of the enhancing lesion was noted on postoperative MRI. His postoperative period was uneventful. On postoperative day 4, he was discharged. Adalimumab was discontinued. Based on further investigations including morphology and immunophenotyping of the brain biopsy specimen, a diagnosis of primary diffuse large B-cell lymphoma of the central nervous system was made. He was started on combination of rituximab and high-dose methotrexate. A follow-up MRI of the brain showed small enhancement around the cavity resection. Hence, he received cranial adiation therapy along with cyclophosphamide, thiotepa and busulfan, followed by an autologous stem cell transplant. At 14 months follow-up after the surgery, he was disease-free. Farah RA, et al. Primary Central Nervous System Lymphoma in a Patient on Adalimumab Therapy for Chronic Plaque Psoriasis. World Neurosurgery 139: 260-263, Jul 2020. 803502455 Available from: URL: http://doi.org/10.1016/j.wneu.2020.03.155
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Reactions 26 Sep 2020 No. 1823
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