Guillain-Barre Syndrome Developing During InfliximabTreatment for Psoriatic Arthritis: A Case Report

Polyneuropathy developing after infliximab therapy in a patient with recalcitrant pyoderma gangrenosum

“…CNS autoimmune demyelinating disorders (DD) include development of multiple sclerosis (MS), MS-like disorders, retrobulbar optic neuritis, and transverse myelitis. Peripheral nerve disorders induced by anti-TNF agents include Guillain-Barré and Miller-Fisher syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, multifocal motor neuropathy, distal symmetric polyneuropathy, mononeuritis simplex/multiplex, and axonal sensorimotor polyneuropathies 4,5,[12][13][14][15] . The prevalence of adverse neurological events induced by TNF-α inhibitors is thought to be between 0.05% and 0.20% 16 .…”

“…RPLS is not a demyelinating disease and is characterized by confusion, headache, visual disturbances, and seizures 21 . The mechanisms by which anti-TNF agents induce DD is not fully understood 13 . It has been demonstrated that TNF Receptor 1 (TNFR1) plays a role in CNS inflammation, apoptosis and demyelination, while TNF Receptor 2 (TNFR 2) acts to limit tissue pathology by suppressing autoreactive CD4+ T cells and plays a role in remyelination 23 .…”

“…Anti-TNF agents may interfere with regulatory T cell function, trigger autoantibody production towards myelin, increase the function of antigen presenting cells or cause ischemia of nerve tissue secondary to vasculitis. Inhibition of TNF-α may also prevent the repair of axonal injuries and myelin damage 4,12,13,15,18,24 . Additionally, it has been proposed that TNF-α provides signaling support to peripheral neurons and its sequestration with TNF-α inhibitors interrupts such support 25 .…”