Case Report: TNF-α Inhibitor-Associated Demyelinating Disease

Area of Science:

• Neurology
• Immunology
• Pharmacology

Background:

• Tumor necrosis factor-alpha inhibitors (TNF-αi's) are effective treatments for autoimmune diseases like ulcerative colitis (UC).
• Rarely, TNF-αi's have been linked to central nervous system demyelination, typically within the first year of use.
• This case explores a delayed onset of demyelination associated with Infliximab.

Purpose of the Study:

• To report a rare case of central demyelinating lesion secondary to Infliximab.
• To highlight a delayed adverse effect of TNF-αi therapy.
• To emphasize the importance of considering medication side effects even after long-term use.

Main Methods:

• Case report of a 39-year-old male with UC on long-term Infliximab therapy.
• Clinical presentation of paresthesia and weakness.
• Magnetic Resonance Imaging (MRI) revealing cortical enhancement.
• Exclusion of other potential causes.
• Treatment with corticosteroids and Infliximab suspension.

Main Results:

• A 39-year-old male developed central demyelinating lesions after several years of Infliximab use.
• Symptoms included left-sided extremity paresthesia and weakness.
• MRI showed right-sided cortical enhancement.
• Discontinuation of Infliximab and corticosteroid treatment led to full recovery.

Conclusions:

• Central nervous system demyelination can occur as a rare side effect of Infliximab, even after years of treatment.
• This case occurred outside the typical timeframe for such adverse events.
• Clinicians should consider TNF-αi's as potential causes of neurological symptoms, regardless of treatment duration.