1
|
Ayadi S, Hammouga R, Slim Majoul M, Jamoussi H, Zaimi Y, Mensi A, Fredj M, Mouelhi L. Guillain-Barré syndrome in ulcerative colitis and SARS-CoV-2 infection: a case report and literature review. Future Sci OA 2024; 10:FSO913. [PMID: 38817380 PMCID: PMC11137770 DOI: 10.2144/fsoa-2023-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/03/2023] [Indexed: 06/01/2024] Open
Abstract
Aim: Guillain-Barré syndrome (GBS) occurrence is rare during inflammatory bowel disease (IBD) and SARS-CoV-2 infection. Its association with thrombotic vascular events, which are common during these two entities, is extremely rare. Case report: We report an exceptional association of GBS and cerebral venous thrombosis in a 28-year-old woman with active ulcerative colitis and no previous history of SARS-CoV-2 vaccination. Mildly symptomatic SARS-CoV-2 infection was diagnosed during etiological investigations of cerebral venous thrombosis. GBS symptoms began 10 days later with clinical and electrical abnormalities consistent with axonal GBS. Other GBS causes were excluded. Favorable outcomes were noted after intravenous immunoglobulin perfusion with full recovery 12 months later. Conclusion: Greater attention should be focused on IBD patients with SARS-CoV-2 infection regardless of its severity.
Collapse
Affiliation(s)
- Shema Ayadi
- Gastroenterology Department, Charles Nicolle University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Rabeb Hammouga
- Gastroenterology Department, Charles Nicolle University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Slim Majoul
- Neurology Department, Charles Nicolle University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hela Jamoussi
- Neurology Department, Charles Nicolle University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Yosra Zaimi
- Gastroenterology Department, Charles Nicolle University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Asma Mensi
- Gastroenterology Department, Charles Nicolle University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Fredj
- Neurology Department, Charles Nicolle University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Leila Mouelhi
- Gastroenterology Department, Charles Nicolle University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| |
Collapse
|
2
|
Tominaga K, Tsuchiya A, Sato H, Kimura A, Oda C, Hosaka K, Kawata Y, Kimura N, Hayashi K, Yokoyama J, Terai S. Co-existent ulcerative colitis and Guillain-Barré syndrome: a case report and literature review. Clin J Gastroenterol 2019; 12:243-246. [PMID: 30778832 DOI: 10.1007/s12328-019-00939-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/15/2019] [Indexed: 12/25/2022]
Abstract
Ulcerative colitis (UC) is a chronic and recurrent inflammatory disease involving the intestine, and Guillain-Barré Syndrome (GBS) is rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. UC and GBS can be caused by immune system abnormalities and can co-exist. To date, there are 7 reported cases of GBS in patients with UC. However, only one patient developed UC after GBS treatment. We report a rare case of UC that appeared after intravenous immunoglobulin therapy for GBS. This case report and literature review will allow accurate and prompt diagnosis of co-existent GBS and UC.
Collapse
Affiliation(s)
- Kentaro Tominaga
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Atsunori Tsuchiya
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan.
| | - Hiroki Sato
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Atsushi Kimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Chiyumi Oda
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Kazunori Hosaka
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Yuzo Kawata
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Naruhiro Kimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Kazunao Hayashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Junji Yokoyama
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| |
Collapse
|
3
|
Abstract
RATIONALE Ulcerative colitis is a chronic and recurrent inflammatory disease involving the intestine. It is reported that about 40% of patients with ulcerative colitis have extraintestinal manifestations, where as the literature on neurological involvement as extraintestinal manifestation is rather limited. Guillain-Barré syndrome is an abnormal immune-mediated and acute-acquired demyelinating disease that mainly affects the peripheral nervous system and often has a phenomenon of protein-cell separation of cerebrospinal fluid. Here, we report a rare case of ulcerative colitis with Guillain-Barré Syndrome. PATIENT CONCERNS We described a patient with Guillain-Barré syndrome during the remission period of ulcerative colitis. Clinical manifestations are the numbness of the upper extremities, weakness in the limbs and the inability of the fingers companion. Cerebrospinal fluid (CSF) showed albuminocytological dissociation and electromyography suggested neurogenic lesion. DIAGNOSES Ulcerative colitis with Guillain-Barré syndrome was diagnosed based on the history of ulcerative colitis, related symptoms, typical cerebrospinal fluid albuminocytological dissociation and evidence of neurogenic injury through electromyography. INTERVENTIONS The patient was treated with intravenous (IV) methylprednisolone. OUTCOMES After the treatment of glucocorticoid, the symptoms of the nervous system were disappeared. LESSONS Neurological involvement of extraintestinal manifestation during the remission period of ulcerative colitis also exists in the clinic. This case highlights the need for diagnostic vigilance in cases of ulcerative colitis involving the peripheral nerves during the remission period. We recommend cerebrospinal fluid examination and electromyography in view of rare but serious possibility of Guillain-Barré syndrome.
Collapse
Affiliation(s)
| | - Ke Zhou
- Department of Neurology, Renmin Hospital of Wuhan University, Hubei Province, China
| | | | | |
Collapse
|
4
|
Lincoln CM, Fata P, Sotardi S, Pohlen M, Uribe T, Bello JA. Imaging spectrum of immunomodulating, chemotherapeutic and radiation therapy-related intracranial effects. Br J Radiol 2017; 91:20170553. [PMID: 29039692 DOI: 10.1259/bjr.20170553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE A wide range of treatment-related side effects result in specific neurologic symptoms and signs and neuroimaging features. Even to the most seasoned neuroradiologist, elucidating therapy-related side effects from other common mimics can be challenging. We provide a pictorial survey of some common and uncommon medication-induced and therapy-related neuroimaging manifestations, discuss pathophysiology and common pitfalls in imaging and diagnosis. METHODS A case-based review is utilized to depict scenarios on a routine basis in a general radiology or neuroradiology practice such as medication-induced posterior reversible encephalopathy syndrome to the more challenging cases of pseudoprogression and pseudoregression in temozolmide and bevacizumab therapy in gliobastoma treatment protocols. CONCLUSION Knowledge of the treatment-induced imaging abnormalities is essential in the accurate interpretation and diagnosis from the most routine to most challenging of clinical situations. We provide a pictorial review for the radiologist to employ in order to be an invaluable provider to our clinical colleagues and patients.
Collapse
Affiliation(s)
- Christie M Lincoln
- 1 Department of Radiology, Baylor College of Medicine , Houston, TX , USA
| | - Peter Fata
- 2 Department of Radiology, Houston Methodist , Houston, TX , USA
| | - Susan Sotardi
- 3 Department of Neuroradiology, Massachusetts General Hospital , Boston, MA , USA
| | - Michael Pohlen
- 1 Department of Radiology, Baylor College of Medicine , Houston, TX , USA
| | - Tomas Uribe
- 1 Department of Radiology, Baylor College of Medicine , Houston, TX , USA
| | - Jacqueline A Bello
- 4 Albert Einstein College of Medicine, Montefiore Medical Center , Bronx, NY , USA
| |
Collapse
|
5
|
Patwala K, Crump N, De Cruz P. Guillain-Barré syndrome in association with antitumour necrosis factor therapy: a case of mistaken identity. BMJ Case Rep 2017; 2017:bcr-2017-219481. [PMID: 28679512 PMCID: PMC5534643 DOI: 10.1136/bcr-2017-219481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 11/04/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an immune-mediated disease characterised by evolving ascending limb weakness, sensory loss and areflexia. Two-thirds of GBS cases are associated with preceding infection. However, GBS has also been described in association with antitumour necrosis factor (TNF) therapies including infliximab and adalimumab for chronic inflammatory disorders such as rheumatoid arthritis, ankylosing spondylitis and inflammatory bowel disease. We present the case of a patient who developed GBS while undergoing treatment with adalimumab in combination with azathioprine for severe fistulising Crohn's disease, and review the literature on neurological adverse events that occur in association with anti-TNF therapy. We also propose an approach to the optimal management of patients who develop debilitating neurological sequelae in the setting of anti-TNF therapy.
Collapse
Affiliation(s)
- Kurvi Patwala
- Department of Gastroenterology, Austin Health, Heidelberg, Australia
| | - Nicholas Crump
- Department of Neurology, Austin Health, Heidelberg, Australia
| | - Peter De Cruz
- Department of Gastroenterology, Austin Health, Heidelberg, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
6
|
Cançado GGL, Vilela EG. Guillain-Barré syndrome during adalimumab therapy for Crohn´s disease: coincidence or consequence? Scand J Gastroenterol 2017; 52:473-476. [PMID: 27931132 DOI: 10.1080/00365521.2016.1263682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report the case of a 64-year-old patient diagnosed with extensive ileal Crohn´s disease who developed Guillain-Barré syndrome after starting biological therapy with adalimumab. Neurologic involvement associated with inflammatory bowel diseases is recognized as an extra-intestinal manifestation. After the breakthrough of antitumor necrosis factor alpha (anti-TNF-α) agents, an increasing number of cases of acute inflammatory demyelinating polyneuropathies have been reported; however, only one case has been described in a patient with Crohn´s disease. Although a causal relationship between Guillain-Barré syndrome and TNF-α antagonist therapy cannot be proven, this report emphasizes the need to monitor for neurologic signs and symptoms in patients with inflammatory bowel diseases, with or without biological therapy, to avoid severe and irreversible complications associated with demyelinating diseases.
Collapse
Affiliation(s)
- Guilherme Grossi Lopes Cançado
- a Instituto Alfa de Gastroenterologia , Hospital das Clínicas da Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Eduardo Garcia Vilela
- a Instituto Alfa de Gastroenterologia , Hospital das Clínicas da Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| |
Collapse
|
7
|
Levy-Clarke G, Jabs DA, Read RW, Rosenbaum JT, Vitale A, Van Gelder RN. Expert Panel Recommendations for the Use of Anti–Tumor Necrosis Factor Biologic Agents in Patients with Ocular Inflammatory Disorders. Ophthalmology 2014; 121:785-96.e3. [DOI: 10.1016/j.ophtha.2013.09.048] [Citation(s) in RCA: 327] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 09/24/2013] [Accepted: 09/30/2013] [Indexed: 12/14/2022] Open
|
8
|
Katsanos AH, Katsanos KH. Inflammatory bowel disease and demyelination: more than just a coincidence? Expert Rev Clin Immunol 2014; 10:363-73. [PMID: 24490959 DOI: 10.1586/1744666x.2014.885381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Infliximab and other anti-TNF-α agents have been implicated for drug-induced demyelination in patients with inflammatory bowel diseases (IBDs). We evaluated existing data from MEDLINE and EMBASE and conducted a narrative review to investigate further the aforementioned association. Our literature search highlighted 34 case reports, 3 case-control studies, 1 prospective and 7 retrospective cohort studies published in English. Available data suggest that IBD patients can manifest demyelinating events in both central and peripheral nervous system, however, they are still insufficient to conclude whether anti-TNF-α therapies are an independent risk factor for demyelination. Prospective cohort studies with internal control groups are needed to estimate the true incidence of demyelinating disorders in patients with IBD and to elucidate if anti-TNF-α therapy increases further the risk of demyelination.
Collapse
Affiliation(s)
- Aristeidis H Katsanos
- Department of Neurology, University of Ioannina, School of Medicine, Ioannina, Greece
| | | |
Collapse
|
9
|
Abstract
Peripheral neuropathies should be recognized as the adverse effects of biological agents, especially anti-TNF agents. However, no solid clinical databases for biological agent-associated peripheral neuropathies (BAPN) have been established in Japan. Here we report two cases of peripheral neuropathy associated with anti-TNF agents. One was peroneal motor neuropathy. The other case was chronic inflammatory demyelinating polyradiculoneuropathy. In addition, we summarize the previous reports on BAPN and discuss their prevalence rate, pathogenesis and management.
Collapse
Affiliation(s)
- Masato Yagita
- a Department of Clinical Immunology and Rheumatology , The Tazuke-Kofukai Medical Research Institute, Kitano Hospital , Osaka , Japan
| | - Toshiaki Hamano
- b Department of Neurology , Kansai Electric Power Hospital , Osaka , Japan
| | - Saori Hatachi
- a Department of Clinical Immunology and Rheumatology , The Tazuke-Kofukai Medical Research Institute, Kitano Hospital , Osaka , Japan
| | - Masaaki Fujita
- c Department of Dermatology , University of California Davis School of Medicine , Sacramento , CA , USA
| |
Collapse
|
10
|
Birnbaum J, Bingham CO. Non-length-dependent and length-dependent small-fiber neuropathies associated with tumor necrosis factor (TNF)-inhibitor therapy in patients with rheumatoid arthritis: expanding the spectrum of neurological disease associated with TNF-inhibitors. Semin Arthritis Rheum 2013; 43:638-47. [PMID: 24439654 DOI: 10.1016/j.semarthrit.2013.10.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/21/2013] [Accepted: 10/24/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Small-fiber neuropathy causes severe burning pain, requires diagnostic approaches such as skin biopsy, and encompasses two subtypes based on distribution of neuropathic pain. Such biopsy-proven subtypes of small-fiber neuropathies have not been previously described as complications of tumor necrosis factor (TNF)-inhibitor therapy. METHODS We therefore characterized clinical and skin biopsy findings in three rheumatoid arthritis (RA) patients who developed small-fiber neuropathies associated with TNF-inhibitors. We also conducted a systematic review of the literature to characterize subtypes of neuropathies previously reported in association with TNF-inhibitor therapy. RESULTS Two patients presented with a "non-length-dependent" small-fiber neuropathy, experiencing unorthodox patterns of burning pain affecting the face, torso, and proximal extremities. Abnormal skin biopsy findings were limited to the proximal thigh, which is a marker of proximal-most dorsal root ganglia degeneration. In contrast, one patient presented with a "length-dependent" small-fiber neuropathy, experiencing burning pain only in the feet. Abnormal skin biopsy findings were limited to the distal feet, which is a marker of distal-most axonal degeneration. One patient developed a small-fiber neuropathy in the context of TNF-inhibitor-induced lupus. In all patients, neuropathies occurred during TNF-inhibitor-induced remission of RA disease activity and improved on withdrawal of TNF-inhibitors. CONCLUSIONS We describe a spectrum of small-fiber neuropathies not previously reported in association with TNF-inhibitor therapy, with clinical and skin biopsy findings suggestive of dorsal root ganglia as well as axonal degeneration. The development of small-fiber neuropathies during inactive joint disease and improvement of neuropathic pain upon withdrawal of TNF-inhibitor suggest a causative role of TNF-inhibitors.
Collapse
Affiliation(s)
- Julius Birnbaum
- Division of Rheumatology, The Johns Hopkins University School of Medicine, 5200 Eastern Ave, Baltimore, MD 21224.
| | - Clifton O Bingham
- Department of Neurology, The Johns Hopkins University School of Medicine, 5200 Eastern Ave, Baltimore, MD 21224
| |
Collapse
|
11
|
Alvarez-Lario B, Prieto-Tejedo R, Colazo-Burlato M, Macarrón-Vicente J. Severe Guillain–Barré syndrome in a patient receiving anti-TNF therapy. Consequence or coincidence. A case-based review. Clin Rheumatol 2013; 32:1407-12. [DOI: 10.1007/s10067-013-2272-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
|
12
|
Artornsombudh P, Gevorgyan O, Payal A, Siddique SS, Foster CS. Infliximab Treatment of Patients with Birdshot Retinochoroidopathy. Ophthalmology 2013. [DOI: 10.1016/j.ophtha.2012.05.048] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
|
13
|
Abstract
INTRODUCTION Neurological deficits that occur during treatment with tumor necrosis factor (TNF)-α antagonists are rare, and their clinical features have not been fully elucidated. METHODS Retrospective review of medical records of 9 patients who were given TNF-α antagonists, subsequently developed neurological deficits and were cared for at the Medical University of South Carolina between January 2002 and May 2010. Adverse drug reaction probability scale was used for the assessment of their causal connection. RESULTS The underlying diseases for which TNF-α antagonists were administered included rheumatologic disorders (4), sarcoidosis (3), psoriasis (1) and Crohn's disease (1). Etanercept, infliximab or adalimumab was administered to these patients. Neurological complications included central or peripheral demyelination (5), antiphospholipid syndrome/central nervous system lupus (1), Epstein-Barr virus encephalitis (1), axonal sensory polyneuropathy (1) and small fiber polyneuropathy (1). TNF-α antagonists were discontinued in 8 patients and clinical improvement was seen in 3 of them. Additional therapies were given in 4 patients. An adverse drug reaction probability score suggested probable (3/9) and possible (6/9) causal relationships. CONCLUSIONS Neurological deficits that develop during treatment with TNF-α antagonists are relatively rare but important potential complications of these drugs. Determining if the relationship between the neurological deficits and TNF-α antagonist therapy is causal can be challenging and can impact patient care.
Collapse
|
14
|
Severe meningo-radiculo-neuritis associated with ipilimumab. Invest New Drugs 2012; 30:2407-10. [PMID: 22231551 DOI: 10.1007/s10637-011-9787-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 12/21/2011] [Indexed: 01/28/2023]
Abstract
PURPOSE Ipilimumab is a T-cell-potentiating monoclonal antibody directed against cytotoxic T-lymphocyte antigen-4 (CTLA-4) to promote antitumoural immunity. In phase III trials, ipilimumab was shown to be the first agent to improve survival in advanced melanoma patients, regardless of previous treatment. We report a case of severe neurologic disease after ipilimumab treatment. PATIENT AND METHODS Neurologic symptoms including facial diplegia, tetraplegia, areflexia progressed with time a few days after the fourth monthly ipilimumab infusion. Analysis of the cerebro-spinal fluid showed elevated proteinorachy and lymphocytic meningitis. Despite high doses of steroids and symptomatic treatment, the symptoms worsened. RESULTS Veinoglobulins were then infused and the patient began to improve and recovered almost normal activity two years later. CONCLUSION The adverse event profile associated with ipilimumab was primarily immune-related. This is the first case in which such a severe event has been reported.
Collapse
|
15
|
Cesarini M, Angelucci E, Foglietta T, Vernia P. Guillain-Barrè syndrome after treatment with human anti-tumor necrosis factorα (adalimumab) in a Crohn's disease patient: case report and literature review. J Crohns Colitis 2011; 5:619-22. [PMID: 22115384 DOI: 10.1016/j.crohns.2011.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 06/26/2011] [Accepted: 06/27/2011] [Indexed: 01/02/2023]
Abstract
Anti-tumor necrosis factor alpha antibodies have been used with increasing frequency despite the number of reported adverse effects. Further new information is still emerging. Here we report the case of a 71-years-old patient affected by Crohn's disease and HCV-positive who developed Guillain-Barrè syndrome after four injections of fully human anti-tumor necrosis factor alpha antibodies (adalimumab). Indication for the treatment was severe clinical recurrence of Crohn's disease following intestinal resection. Guillain-Barrè syndrome was treated by intravenous immunoglobulins, and methylprednisolone and plasmapheresis were started with a progressive partial resolution of neurological symptoms. To date, Crohn's disease was maintained in clinical remission with low dose steroid therapy.
Collapse
Affiliation(s)
- Monica Cesarini
- Gastroenterology Unit, “Sapienza” University of Rome, Rome, Italy
| | | | | | | |
Collapse
|
16
|
Solomon AJ, Spain RI, Kruer MC, Bourdette D. Inflammatory neurological disease in patients treated with tumor necrosis factor alpha inhibitors. Mult Scler 2011; 17:1472-87. [DOI: 10.1177/1352458511412996] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: TNF alpha inhibitor (TNFAI) therapy has been associated with inflammatory neurological syndromes. Objectives: To present 10 new cases of TNFAI associated neurological disease and a review of the literature. Methods: The design and methods were based on case series collected from Oregon Health & Sciences University and the Department of Veterans Affairs Hospital in Portland, Oregon and PubMed review. Results: We describe eight demyelinating central nervous system syndromes and two peripheral nervous system syndromes associated with TNFAI therapy. Characteristics from these cases are analyzed with data from 141 additional cases from the literature. Onset was between the ages of 36 and 65 years in 84% of CNS cases, distinguishing TNFAI-associated disease from sporadic multiple sclerosis. Symptoms occurred within one year of TNFAI therapy in 71%. Etanercept therapy was reported in the majority of cases of CNS syndromes and infliximab therapy in the majority of neuromuscular syndromes. Significant disability remained in 67% of cases although 82% had been followed for less than one year. Conclusions: Our case series and literature review demonstrates an association between TNFAI therapy and inflammatory neurological disease. While a causal relationship is suggested, this remains uncertain. TNFAI-associated neurological syndromes are associated with significant disability and longer follow-up is needed to better determine natural history and evaluate appropriate treatment interventions.
Collapse
Affiliation(s)
- Andrew J Solomon
- Department of Neurology, University of Vermont College of Medicine, Fletcher Allen Health Care, University Health Center, Vermont, USA
| | - Rebecca I Spain
- Oregon Health & Science University, Department of Neurology, USA
| | - Michael C Kruer
- Departments of Pediatrics, Neurology, & Neuroscience Sanford Children’s Health Research Center University of South Dakota Sanford School of Medicine Sioux Falls, SD, USA
| | - Dennis Bourdette
- Oregon Health & Science University, Department of Neurology, USA
| |
Collapse
|
17
|
Stübgen JP. Drug-induced dysimmune demyelinating neuropathies. J Neurol Sci 2011; 307:1-8. [DOI: 10.1016/j.jns.2011.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 05/05/2011] [Accepted: 05/11/2011] [Indexed: 12/30/2022]
|
18
|
Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|