{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T01:27:38Z","timestamp":1784942858607,"version":"3.55.0"},"reference-count":16,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,8,8]],"date-time":"2022-08-08T00:00:00Z","timestamp":1659916800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Toxoplasmosis is one of the most common opportunistic infections, mainly reported in patients with acquired immunodeficiency syndrome (AIDS). Patients with rheumatoid arthritis (RA) have also been linked to reactivation of toxoplasmosis due to immunosuppressive treatment, although biologic drugs have seldom been implicated. We present a case of cerebral toxoplasmosis in a 62-year-old female patient with RA after initiation of biologic therapy (adalimumab). The patient had detectable serum IgG antibodies to toxoplasma gondii, was also on chronic treatment with other non-biologic drugs and presented with worsening disorientation, unsteady gait and left hemiparesis. Imaging studies showed a space-occupying lesion in the right basal ganglia with ring-enhancement. Brain biopsy confirmed the diagnosis of toxoplasmosis and the patient was treated with pyrimethamine and sulfadiazine for 6 weeks, showing complete recovery on follow-up. A review of the literature yielded other four case reports of cerebral toxoplasmosis implying biologic drugs; however, data concerning toxoplasmosis serologic testing, prophylaxis and treatment in these patients are lacking. Each case must be carefully evaluated prior to treatment and a high-index of suspicion in seropositive patients is warranted. Since the use of biologic drugs is increasing, further research is needed to establish practical guidelines for seropositive patients receiving immunosuppressive treatment.<\/jats:p>","DOI":"10.3390\/brainsci12081050","type":"journal-article","created":{"date-parts":[[2022,8,8]],"date-time":"2022-08-08T21:09:18Z","timestamp":1659992958000},"page":"1050","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Cerebral Toxoplasmosis as an Uncommon Complication of Biologic Therapy for Rheumatoid Arthritis: Case Report and Review of the Literature"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4656-0866","authenticated-orcid":false,"given":"Gon\u00e7alo Borges","family":"de Almeida","sequence":"first","affiliation":[{"name":"Department of Neuroradiology, Hospital de S\u00e3o Jos\u00e9, 1150-199 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Crist\u00f3v\u00e3o","sequence":"additional","affiliation":[{"name":"Department of Pathology, Hospital de S\u00e3o Jos\u00e9, 1150-199 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Pontinha","sequence":"additional","affiliation":[{"name":"Department of Pathology, Hospital de S\u00e3o Jos\u00e9, 1150-199 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gon\u00e7alo","family":"Janu\u00e1rio","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital de S\u00e3o Jos\u00e9, 1150-199 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"117223","DOI":"10.1016\/j.jns.2020.117223","article-title":"Toxoplasmosis of the central nervous system: Manifestations vary with immune responses","volume":"420","author":"Graham","year":"2021","journal-title":"J. Neurol. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1148\/rg.294085205","article-title":"Best cases from the AFIP: Cerebral Toxoplasmosis","volume":"29","author":"Lee","year":"2009","journal-title":"RadioGraphics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1093\/rheumatology\/kev115","article-title":"Toxoplasmosis in immunosuppressed patients: Fig. 1","volume":"54","author":"Lewis","year":"2015","journal-title":"Rheumatology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e00115-19","DOI":"10.1128\/CMR.00115-19","article-title":"Epidemiology, Pathophysiology, Diagnosis, and Management of Cerebral Toxoplasmosis","volume":"34","author":"Elsheikha","year":"2020","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"809811","DOI":"10.3389\/fneur.2022.809811","article-title":"Misdiagnosis of HIV With Toxoplasmosis Encephalopathy With Progressive Memory Loss as the Initial Symptom: A Case Report","volume":"13","author":"Wu","year":"2022","journal-title":"Front. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Hosseininejad, Z., Sharif, M., Sarvi, S., Amouei, A., Hosseini, S.A., Chegeni, T.N., Anvari, D., Saberi, R., Gohardehi, S., and Mizani, A. (2018). Toxoplasmosis seroprevalence in rheumatoid arthritis patients: A systematic review and meta-analysis. PLoS Negl. Trop. Dis., 12.","DOI":"10.1371\/journal.pntd.0006545"},{"key":"ref_7","first-page":"e8547","article-title":"Cerebral Toxoplasmosis in a Rheumatoid Arthritis Patient on Immunosuppressive Therapy","volume":"12","author":"Hill","year":"2020","journal-title":"Cureus"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1942","DOI":"10.1136\/annrheumdis-2013-203407","article-title":"Non-viral opportunistic infections in new users of tumour necrosis factor inhibitor therapy: Results of the SAfety Assessment of Biologic ThERapy (SABER) Study","volume":"73","author":"Baddley","year":"2014","journal-title":"Ann. Rheum. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1093\/cid\/ciu185","article-title":"Biologic Therapies in Rheumatoid Arthritis and the Risk of Opportunistic Infections: A Meta-analysis","volume":"58","author":"Kourbeti","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1093\/rheumatology\/ket364","article-title":"Cerebral toxoplasmosis following adalimumab treatment in rheumatoid arthritis","volume":"53","author":"Nardone","year":"2014","journal-title":"Rheumatology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1056\/NEJMc051556","article-title":"Infliximab and Reactivation of Cerebral Toxoplasmosis","volume":"353","author":"Young","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.diagmicrobio.2015.09.009","article-title":"Serological diagnosis of Toxoplasma gondii infection: Recommendations from the French National Reference Center for Toxoplasmosis","volume":"84","author":"Villard","year":"2016","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1177\/147323000403200612","article-title":"Detection of Toxoplasma gondii by Polymerase Chain Reaction in Cerebrospinal Fluid from Human Immunodeficiency Virus-1-infected Japanese Patients with Focal Neurological Signs","volume":"32","author":"Goto","year":"2004","journal-title":"J. Int. Med. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1016\/S0140-6736(04)16412-X","article-title":"Toxoplasmosis","volume":"363","author":"Montoya","year":"2004","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.2217\/fmb.09.89","article-title":"Toxoplasma gondii infection and cerebral toxoplasmosis in HIV-infected patients","volume":"4","author":"Vidal","year":"2009","journal-title":"Futur. Microbiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.2169\/internalmedicine.54.3977","article-title":"Cerebral Toxoplasmosis in a Patient on Methotrexate and Infliximab for Rheumatoid Arthritis","volume":"54","author":"Pulivarthi","year":"2015","journal-title":"Intern. Med."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/12\/8\/1050\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:05:33Z","timestamp":1760141133000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/12\/8\/1050"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,8]]},"references-count":16,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["brainsci12081050"],"URL":"https:\/\/doi.org\/10.3390\/brainsci12081050","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,8]]}}}