J Rheum Dis.  2016 Aug;23(4):250-255. 10.4078/jrd.2016.23.4.250.

A Case of Infliximab-induced Multifocal Motor Neuropathy in a Patient with Rheumatoid Arthritis and Literature Review

• Seo B
• Jeong YJ
• Hong S
• Kim YG
• Lee CK
• Yoo B

• KMID: 2352468
• DOI: http://doi.org/10.4078/jrd.2016.23.4.250

Abstract

Tumor necrosis factor (TNF) inhibitors are increasingly used in treatment of rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis, and inflammatory bowel diseases including Crohn's disease and ulcerative colitis. Rarely, anti-TNF therapy is associated with neurological complications, including both central and peripheral nervous system disorders. To the best of our knowledge, only one case of infliximab-associated multifocal motor neuropathy with conduction block in a patient with spondyloarthropathy has been reported to date in Korea. Here, we report on the case of a 58-year-old Korean woman affected by RA who developed multifocal motor neuropathy after infliximab treatment.

Keyword

Infliximab; Motor neuropathy; Rheumatoid arthritis

MeSH Terms

Arthritis, Psoriatic
Arthritis, Rheumatoid*
Colitis, Ulcerative
Crohn Disease
Female
Humans
Inflammatory Bowel Diseases
Infliximab
Korea
Middle Aged
Peripheral Nervous System Diseases
Spondylarthropathies
Spondylitis, Ankylosing
Tumor Necrosis Factor-alpha
Infliximab
Tumor Necrosis Factor-alpha

Figure

• 

  Figure 1. Motor nerve conduction studies of bilateral median (A, B) and radial (C, D) nerves during the first examination of the study patient, performed several months after symptom onset. It is notable that in panels A and B, the muscle responses after stimulation at the axilla and elbow (arrows) were reduced in amplitude and area by 50% compared with those after a more distal stimulation at the wrist. In panel C, muscle responses after stimulation at the spinal groove and axilla (arrows) showed a 50% reduction in amplitude and area as compared with those after more distal stimulation at the forearm. These findings are in accordance with the definition of a focal motor conduction block across that nerve segment. On the other hand, in panel D, it was evident that the muscle responses after stimulation at the spinal groove and axilla were less than 50% reduced in amplitue and area as compared with those after more distal stimulation at the forearm. NCV: nerve conduction velocity, O: onset, P: peak, T: threshold.

• 

  Figure 2. Three months after stopping infliximab, the conduction blocks of the bilateral median nerves (A, B) showed no interval change compared with the previous motor nerve conduction studies. In panel C, muscle responses after stimulation at the axilla (arrow) were 50% reduced in amplitude and area as compared with those after more distal stimulation at the wrist. O: onset, P: peak, T: threshold.

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