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Sarto J, Caballol B, Berenguer J, Aldecoa I, Carbayo Á, Santana D, Archilla I, Gaig C, Graus F, Panés J, Saiz A. Clinically reversible ustekinumab-induced encephalopathy: case report and review of the literature. Ther Adv Neurol Disord 2022; 15:17562864221079682. [PMID: 35237349 PMCID: PMC8883387 DOI: 10.1177/17562864221079682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/25/2022] [Indexed: 01/11/2023] Open
Abstract
Ustekinumab, a monoclonal antibody against interleukin (IL)-12 and IL-23 approved for the treatment of Crohn’s disease, has shown to be an effective therapy with a favourable safety profile. Clinical trials and real-world studies have reported very few neurological adverse events, including posterior reversible encephalopathy syndrome, idiopathic intracranial hypertension and headache. We describe the case of a 48-year-old man with Crohn’s disease who initiated treatment with ustekinumab on top of ongoing treatment with methotrexate 25 mg/week who presented with an acute-onset encephalopathy that rapidly evolved to severe tetraparesis and akinetic mutism, associated with extensive leukoencephalopathy and restricted diffusion on brain magnetic resonance imaging (MRI), 1 month after the second dose of ustekinumab. Comprehensive in-patient diagnostic testing ruled out vascular, demyelinating, metabolic, tumoral and infectious etiologies. Brain biopsy showed patchy infiltrates of foamy histiocytes with perivascular distribution, associated with edema, diffuse astrocytic gliosis and focal perivascular axonal destruction without demyelination, and ustekinumab-induced neurotoxicity was suspected. After drug discontinuation, the patient presented a complete clinical recovery despite the persistence of leukoencephalopathy. In conclusion, in an era in which biological therapies are continually evolving and expanding, knowledge about the potential neurotoxicity of these new therapies and their management becomes crucial. Although ustekinumab-induced encephalopathy is uncommon, the recognition of this potentially serious side effect is important because prompt withdrawal is associated with a favourable outcome. Whether methotrexate played an additional contributing role is currently unknown, but it is a factor that should be considered.
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Affiliation(s)
- Jordi Sarto
- Neurology Service, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Berta Caballol
- Department of Gastroenterology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Joan Berenguer
- Radiology Service, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Iban Aldecoa
- Department of Pathology, Biomedical Diagnostic Center, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Neurological Tissue Bank of the Biobank, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Álvaro Carbayo
- Neurology Service, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Daniel Santana
- Neurology Service, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ivan Archilla
- Department of Pathology, Biomedical Diagnostic Center, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Carles Gaig
- Neurology Service, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Francesc Graus
- Neuroimmunology Program, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Julián Panés
- Department of Gastroenterology, Hospital Clinic, University of Barcelona, Barcelona, SpainInstitut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Albert Saiz
- Neurology Service, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
- Neuroimmunology Program, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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