Fatal varicella-zoster virus vasculopathy associated with adalimumab therapy.

Objective: To describe the case of a patient who had been receiving adalimumab for rheumatoid arthritis and died of varicella-zoster virus vasculopathy with multifocal cerebral hemorrhage.

Design: Case report.

Setting: Hanyang University Hospital, Seoul, Republic of Korea.

Patient: A 66-year-old woman with adalimumab therapy for rheumatoid arthritis followed by stuporous mental changes.

Results: Magnetic resonance imaging scans showed multifocal parenchymal lesions and hemorrhage in the brainstem and supratentorial areas. Polymerase chain reaction analysis of the cerebrospinal fluid was positive for varicella-zoster virus. The patient died of multifocal vasculopathy despite intensive antiviral and antibacterial medication.

Conclusions: Varicella-zoster virus multifocal vasculopathy with encephalitis may be associated with adalimumab therapy. Clinicians should be aware of the possibility of fatal varicella-zoster virus vasculopathy with encephalitis in patients undergoing adalimumab therapy for rheumatoid arthritis.