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09 April 2024 : Case report  Brazil

[In Press] Guillain-Barré Syndrome in a Patient Receiving Anti-Tumor Necrosis Factor for Crohn Disease: Coincidence or Consequence?

Challenging differential diagnosis, Unusual or unexpected effect of treatment, Adverse events of drug therapy

Sandro da Costa Ferreira ORCID logo1ACDEF, Juarez Roberto de Oliveira Vasconcelos ORCID logo1ABCDEFG, Rosamar Eulira Fontes Rezende ORCID logo1B, Lilian Rose Otoboni Aprile ORCID logo1B, Luiz Ernesto de Almeida Troncon ORCID logo1DEFG

DOI: 10.12659/AJCR.943709

Am J Case Rep In Press; DOI: 10.12659/AJCR.943709  

Available online: 2024-04-09, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Antibodies against tumor necrosis factor alpha (anti-TNF-α) are currently widely used in the treatment of inflammatory bowel diseases (IBD), despite a number of reported adverse effects. Diverse neurologic syndromes, including the Guillain-Barré syndrome (GBS), an immune-mediated disease characterized by evolving ascending limb weakness, sensory loss, and areflexia, have been described in association with anti-TNF-α therapy.
CASE REPORT
A 45-year-old White woman was in follow-up with fistulizing ileocolonic Crohn disease using combination therapy (infliximab plus azathioprine) as CD maintenance therapy. After 3 years of this immunosuppressive therapy, she presented with symmetrical and ascending paresis in the lower limbs, and later in the upper limbs, in addition to reduced reflexes in the knees, 1 day after an infliximab infusion. The patient was hospitalized and treatment for CD was suspended. Neurophysiology studies demonstrated a pattern compatible with acute inflammatory demyelinating polyradiculopathy, with predominantly motor involvement, consistent with Guillain-Barré syndrome (GBS). Clinical, laboratory, and imaging exams were unremarkable. She was treated with intravenous immunoglobulins, with a progressive and complete resolution of neurological symptoms. After 1-year follow-up, she presented with active Crohn disease, and we opted for treating her with vedolizumab, with which she achieved clinical and endoscopic remission.
CONCLUSIONS
Patients receiving biological therapy with anti-TNF-α agents should be monitored for central or peripheral neurological signs and symptoms. The development of GBS can be secondary to anti-TNF-α treatment. The positive temporal relationship with TNF-α therapy and onset of neurological symptoms reinforces this possibility.

Keywords: Inflammatory Bowel Diseases; Infliximab; Paralysis

In Press

Case report  Iran

Simultaneous L1-2 Bulged Disc and Mobile Spinal Schwannoma Causing Cauda Equina Syndrome: A Rare Case Report

Am J Case Rep In Press; DOI: 10.12659/AJCR.942717  

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Case report  Thailand

Severe Complications of Uterine Dehiscence Post-Lower Segment Cesarean Section: A Case Report Emphasizing t...

Am J Case Rep In Press; DOI: 10.12659/AJCR.943027  

Case report  USA

A Prefixed Four-Trunk Brachial Plexus with Anomalous Anatomy of All Subsequent Divisions, Cords, and Termin...

Am J Case Rep In Press; DOI: 10.12659/AJCR.943866  

Case report  USA

Rapid Progression of Malignant Peritoneal Mesothelioma Mimicking a Postoperative Complication in a Young Wo...

Am J Case Rep In Press; DOI: 10.12659/AJCR.942948  

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923