PMC5152954_01
Cerebral MRI Scan with the follow up survey, it showed the essential progression of intracranial lesions. Artifact of V-P-Shunt system.
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Five months after the discontinuation of the adalimumab therapy, we observed cerebral lesions in the basal meningeal region and in the follow- up cerebral MRI- Scan (Fig.1 and Fig 2).
Cerebral MRI Scan with the follow up survey, it showed the essential progression of intracranial lesions. Artifact of V-P- Shunt system.
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Five months after the discontinuation of the adalimumab therapy, we observed cerebral lesions in the basal meningeal region and in the follow- up cerebral MRI- Scan (Fig.1 and Fig 2).
PMC5152954_02
A Contrast enhanced scan showed severe bilateral pulmonary infiltrates. B: Contrast enhanced scan revealed regressive pulmonary infiltrates on both sides after the first course of 2 weeks tuberculosis treatment.
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The initial contrast enhanced CT- Scan revealed severe progressive bilateral pulmonary infiltrates (Fig.3a). After the first treatment course of two weeks antituberculosis treatment with four antibiotics (INH isonicotinic acid hydracide 300 mg daily, RIFA rifampicin 600 mg daily, PZA pyrazinamide 2000 mg daily and SM streptomycin 1000 mg daily), the contrast enhanced CT scan showed regressive bilateral pulmonary infiltrates (Fig.3b).
A. Contrast enhanced CT- Scan of follow- up control 2 weeks after the first course of anti- tuberculous therapy. B: Contrast CT- Scan of follow- up control 6 weeks after the discontinuation of adalimumab therapy showed progressive pulmonary infiltrates on both sides in term of paradoxical reaction.
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Six weeks after the discontinuation of the adalimumab therapy, he developed a prolonged paradoxical reaction with reverse episodes of fever, elevation of CRP 7.1 mg/dl; Leukocyte of 16.0 GIGA/L and LDH of 276 U/L. and progressive bilateral pulmonary infiltration which were revealed in both contrast enhanced CT-scan and chest x- ray (Fig. 4, 5).
A: Chest X- ray 2 weeks after the initiation of the tuberculosis therapy. B: Chest X- ray 6 weeks after the discontinuation of adalimumab therapy, it revealed progressive pulmonary infiltrates in term of paradoxical reaction.
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Six weeks after the discontinuation of the adalimumab therapy, he developed a prolonged paradoxical reaction with reverse episodes of fever, elevation of CRP 7.1 mg/dl; Leukocyte of 16.0 GIGA/L and LDH of 276 U/L. and progressive bilateral pulmonary infiltration which were revealed in both contrast enhanced CT-scan and chest x- ray (Fig. 4, 5).