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- Title
Guillain-Barré Syndrome in a Patient Receiving Anti-Tumor Necrosis Factor for Crohn Disease: Coincidence or Consequence?
- Authors
da Costa Ferreira, Sandro; de Oliveira Vasconcelos, Juarez Roberto; Fontes Rezende, Rosamar Eulira; Otoboni Aprile, Lilian Rose; de Almeida Troncon, Luiz Ernesto
- 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.
- Subjects
CROHN'S disease; GUILLAIN-Barre syndrome; INFLAMMATORY bowel diseases; TUMOR necrosis factors; SYMPTOMS; GASTROPARESIS; IMMUNE reconstitution inflammatory syndrome
- Publication
American Journal of Case Reports, 2024, Vol 25, p1
- ISSN
1941-5923
- Publication type
Case Study
- DOI
10.12659/AJCR.943709