Multiple cranial neuropathies following etanercept administration

Area of Science:

• Neurology
• Immunology
• Dermatology

Background:

• Tumor necrosis factor (TNF) inhibitors are increasingly used for inflammatory conditions.
• Sarcoid-like granulomatosis has been reported as a rare adverse effect of TNF inhibitors.
• Neurosarcoidosis is an uncommon manifestation, with limited cases linked to TNF inhibitors.

Observation:

• This study presents the first documented case of neurosarcoidosis attributed to etanercept.
• The patient exhibited multiple cranial neuropathies, specifically affecting the trigeminal, facial, and vestibulocochlear nerves.
• The clinical presentation necessitated a thorough differential diagnosis for multiple cranial neuropathies.

Findings:

• Etanercept-induced neurosarcoidosis can manifest with significant cranial nerve involvement.
• The development of sarcoid-like granulomatosis is a recognized, albeit rare, complication of TNF inhibitor therapy.
• This case underscores the importance of considering iatrogenic causes for neurosarcoidosis.

Implications:

• Clinicians should be vigilant for neurosarcoidosis in patients treated with TNF inhibitors, particularly etanercept.
• Differential diagnosis of multiple cranial neuropathies should include drug-induced conditions.
• Further research is warranted to understand the mechanisms and incidence of TNF inhibitor-associated neurosarcoidosis.