Neurological disorders with demyelinating brain white matter lesions in a patient with rheumatoid arthritis treated with etanercept.
We present the case of a 37-year-old woman with severe, drug-resistant rheumatoid arthritis. The patient has been previously treated with several disease-modifying anti-rheumatic drugs as well as infliximab alone and in combination therapy. Despite the treatment, a high disease activity persisted. For this reason, the patient was qualified to etanercept therapy. During the therapy, a gradual joint condition improvement was demonstrated, including arthritis remission. From the fourth month of etanercept administration, neurological disorders such as sight and speech disorders, amentia and muscle weakening were reported. The symptoms aggrevated with therapy continuation. The patient reported her complaints to her leading rheumatologist after 8 months of their duration. Optic fundus and visual area examination, as well as in the neurological examination no significant abnormalities were found. Magnetic resonance imaging of the head demonstrated single, small hyperintensive lesions in the T2w images located in the white matter of the frontal and parietal lobes of the left cerebral hemisphere, which could be identical with demyelization. Based on the clinical and laboratory findings, drug-induced neurological disorders associated with etanercept administration were suspected. After discontinuation of etanercept therapy, the complaints gradually subsided. The amentia episodes, concentration disorders and speech disorders were less frequent. There was no relapse of muscle weakening. Within 6 months of the drug discontinuation, neurological symptoms resolved completely.
Internal Medicine and Rheumatology Clinic, Military Institute of Medicine, Warszawa, Poland. a.kur@grochow.2a.pl
Joanna
J
Kur-Zalewska
Justyna
J
Swarowska-Knap
Witold
W
Tłustochowicz
D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003711:Demyelinating Diseases / Q000139:chemically induced*; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D018124:Receptors, Tumor Necrosis Factor; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept