Case report: Breaking CNS immuno-privilege: TNFα-inhibitor triggers aseptic meningitis in a patient with rheumatoid arthritis

Front Immunol. 2024 Sep 10:15:1432360. doi: 10.3389/fimmu.2024.1432360. eCollection 2024.

Abstract

Blood-brain barrier dysfunction might be driven by peripheral inflammation. TNFα inhibitors (TNF-αi) are occasionally associated with a wide spectrum of neurological immuno-mediated disorders. However, patients with systemic autoimmune disorders, including rheumatoid arthritis (RA), might be prone to develop further organ-specific, including central nervous system (CNS), autoimmunity. Here we report the case of a patient, affected by RA and treated with etanercept, who suddenly developed focal neurological symptoms. Cerebrospinal fluid, magnetic resonance imaging (MRI), and positron emission tomography (PET)/MRI findings are reported and support the diagnosis of TNF-αi -associated aseptic meningitis.

Keywords: PET-MRI; aseptic meningitis; blood-brain barrier; cerebrospinal fluid; etanercept; rheumatoid arteritis.

Publication types

  • Case Reports

MeSH terms

  • Antirheumatic Agents / adverse effects
  • Antirheumatic Agents / therapeutic use
  • Arthritis, Rheumatoid* / drug therapy
  • Etanercept* / adverse effects
  • Etanercept* / therapeutic use
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Meningitis, Aseptic* / chemically induced
  • Middle Aged
  • Positron-Emission Tomography
  • Tumor Necrosis Factor Inhibitors / adverse effects
  • Tumor Necrosis Factor Inhibitors / therapeutic use
  • Tumor Necrosis Factor-alpha* / antagonists & inhibitors

Substances

  • Tumor Necrosis Factor-alpha
  • Etanercept
  • Antirheumatic Agents
  • Tumor Necrosis Factor Inhibitors

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Open Access funding provided by Università degli Studi di Padova | University of Padua, Open Science Committee.