Progressive Demyelinating Disease Associated with Adalimumab Treatment in a Patient Diagnosed with Ankylosing Spondylitis.
Case Report
Anti-tumor necrosis factor-alpha (anti-TNF-α) agents have been widely used in the treatment of rheumatic and autoimmune diseases. It was thought that TNF-α blockage could be an appropriate choice in the treatment of multiple sclerosis (MS), however; dose-dependent increase in magnetic resonance imaging (MRI) activity, and frequency and severity of relapses were reported in individuals with MS in clinical studies. Herein a 32-year-old lady diagnosed with ankylosing spondylitis who developed progressive gait disturbance after adalimumab treatment has been presented. Brain and spinal cord MRI revealed demyelinating lesions and oligoclonal bands were positive, in the cerebrospinal fluid. Ocrelizumab treatment was initiated for progressive demyelinating disorder. Patients scheduled for anti-TNF-α treatment should be carefully evaluated for demyelinating diseases, and patients receiving this treatment should be closely monitored for emerging neurological findings. In individuals with demyelinating disease related to anti-TNF- α treatment, decisions on long-term immunomodulatory treatment should be tailored for each patient.
