Case Report: TNF-α Inhibitor-Associated Demyelinating Disease

Tumor necrosis factor-alpha inhibitors (TNF-αi's) such as Infliximab are effective treatments for various autoimmune diseases. However, in rare instances, they have been implicated in central nervous system demyelination. Typically, this side effect is seen within the first year of medication exposure. This case reports on the rare occurrence of a central demyelinating lesion secondary to Infliximab after several years of uncomplicated use. A 39-year-old, right-handed male with a history of ulcerative colitis (UC) was being maintained on infliximab therapy for several years before presenting to the emergency room. He reported weeks of intermittent, worsening left-sided extremity paresthesia and weakness. Initial workup ruled-out a stroke, but subsequent MRI revealed a strange right-sided cortical enhancement that anatomically corresponded to the patients' complaints. Ruling out other possibilities, the patient's TNF-αi medication became a concern. Treatment with corticosteroids and suspension of the patient's infliximab enabled a swift improvement and gradual full recovery. The patient's UC medication was subsequently changed as he returned to baseline. This case demonstrates a rare complication of a commonly prescribed medication that appeared well outside the timeframe of similar other case reports, highlighting the importance of considering TNF-αi side-effects as possible contributory factors to disease states even after many years of relative stability.