Intractable pneumococcal meningoencephalitis associated with a TNF-alpha antagonist

Abstract

A 34-year-old man was treated with a TNF-alpha antagonist for ankylosing spondylitis, and this subsequently developed a CNS infection. Magnetic resonance imaging showed diffuse subcortical white matter lesions. Streptococcus pneumoniae was cultured from the cerebrospinal fluid and blood. The patient died of multifocal widespread brain damage and subarachnoid hemorrhage, despite intensive antibacterial medication. Pneumococcal meningoencephalitis can occur in association with TNF-alpha antagonists. Clinicians should be aware of both the risk of fatal bacterial meningoencephalitis associated with TNF-alpha antagonists and the possibility of an unusual presentation of bacterial meningitis.