TNF and Opportunistic infection: Adalimumab therapy reduces the levels of TNF-alpha, but exacerbates the risk of opportunistic infections by two-fold.[1] Studies have reported infections of the upper and lower respiratory tract, skin and soft tissue, bones and joints in patients receiving adalimumab therapy.[2] Besides tuberculosis, other infections, including bacterial, viral and fungal infections, have been documented in prior cases receiving adalimumab treatment.[3] However, CNS infections in patients receiving adalimumab treatment are rare.