TY - JOUR T1 - Neuromeningeal Tuberculosis in a Patient with Rheumatoid Arthritis Previously Exposed to Ineffective Etanercept Therapy and Revealed by Infliximab JF - The Journal of Rheumatology JO - J Rheumatol SP - 471 LP - 471 DO - 10.3899/jrheum.090241 VL - 37 IS - 2 AU - VIRGINIE DaSILVA AU - CHRISTIAN H. ROUX AU - EVELYNE BERNARD AU - OLIVIER BROCQ AU - CHRISTINE ALBERT AU - HASNA CHAMI AU - CHRISTIAN GRISOT AU - YACINE ALLAM AU - PIERRE DELLAMONICA AU - LIANA EULLER-ZIEGLER Y1 - 2010/02/01 UR - http://www.jrheum.org/content/37/2/471.abstract N2 - We describe the case of a 74-year-old French Caucasian woman, born in Nice, a former storekeeper, with a history of seropositive and erosive rheumatoid arthritis (RA) dating from 1993. She had been treated unsuccessfully (inefficacy or severe side effects) with hydroxychloroquine, methotrexate, and leflunomide. In February 2002, she was given infliximab 3 mg/kg/8 weeks in combination with leflunomide 20 mg per day. Hepatic cytolysis necessitated discontinuation in February 2005. Etanercept alone was tried for 7 months, also unsuccessfully. The hepatic cytolysis was subsequently attributed to the use of nonsteroidal antiinflammatory drugs. In October 2005, infliximab was introduced (5 mg/kg/8 wks) in association with leflunomide (10 mg/day) without glucocorticoids. In September 2006, she was admitted to our department with headache, tiredness, equilibrium disturbances, and a clinical cerebellar syndrome. Treatment was discontinued but, 24 h later, right flaccid hemiplegia appeared with dysarthria. Brain computed tomography scan showed a pattern of cerebrovascular ischemic accident, and she was treated with low molecular weight heparin plus platelet antiaggregants. The motor deficiency was resolved within a few days, but temporospatial disorientation and confusion were still present 5 days after hospitalization. The confusion syndrome worsened, with fever (39.1°C) and symptoms of meningitis. Cerebrospinal fluid (CSF) was clear, 200 elements/mm3, with lymphocyte predominance (99%), high proteinorrhachia [2.73 g/l (normal 0.15–0.45)] … Address correspondence to Dr. Da Silva. E-mail: dasilva.v{at}chu-nice.fr ER -