Sensorimotor polyneuropathy with 5-aminosalicylic acid: a case report

Area of Science:

• Neurology
• Gastroenterology
• Pharmacology

Background:

• Ulcerative colitis (UC) is a chronic inflammatory bowel disease.
• Treatment for UC often involves aminosalicylates like sulfasalazine (SASP) and 5-aminosalicylic acid (5-ASA).
• Neurological complications are rare but serious adverse effects of UC medications.

Observation:

• A 69-year-old male with UC initially treated with SASP experienced UC symptom resolution but developed skin eruptions and lower limb dysesthesia.
• Switching to 5-ASA resolved skin issues but led to right arm weakness, progressive leg dysesthesia, gait disturbance, and absent deep tendon reflexes.
• Discontinuation of 5-ASA resulted in a gradual recovery of the patient's sensorimotor polyneuropathy.

Findings:

• The patient's clinical presentation and symptom progression strongly implicate 5-ASA as the causative agent of sensorimotor polyneuropathy.
• The adverse neurological effects appeared to be dose- or duration-dependent, resolving upon drug cessation.
• This case highlights a potential link between 5-ASA and iatrogenic polyneuropathy.

Implications:

• Clinicians should consider 5-ASA-induced polyneuropathy in UC patients presenting with unexplained neurological deficits.
• Early recognition and discontinuation of 5-ASA may be crucial for managing and reversing these neurological complications.
• Further research is warranted to elucidate the mechanisms underlying 5-ASA neurotoxicity and to establish diagnostic criteria.