[Mononeuritis multiplex under the TNF-alpha inhibitor infliximab]

Area of Science:

• Neurology
• Immunology
• Rheumatology

Background:

• Ankylosing spondylitis is a chronic inflammatory disease.
• Tumor necrosis factor-alpha (TNF-α) inhibitors like infliximab are used for treatment.
• Peripheral nervous system complications are rare side effects of TNF-α inhibitors.

Observation:

• A 21-year-old patient with ankylosing spondylitis on infliximab developed multifocal demyelinating axonal neuropathy.
• The condition presented as mononeuritis multiplex, affecting multiple peripheral nerves concurrently.
• The exact cause of this neuropathy in the context of infliximab therapy remains unclear.

Findings:

• Infliximab, a TNF-α inhibitor, was associated with a rare peripheral nervous system side effect.
• The patient experienced simultaneous impairment of several peripheral nerves.
• Intravenous immunoglobulin therapy (0.4 g/kg/day for five days) was administered.

Implications:

• This case highlights a potential, albeit rare, neurological complication of infliximab therapy.
• Early recognition and intervention with treatments like intravenous immunoglobulin may be beneficial.
• Further research is needed to elucidate the underlying mechanisms of this adverse event.