Tumefactive demyelinating lesions during etanercept treatment requiring decompressive hemicraniectomy.
Tumor necrosis factor alpha (TNF-α) is a pro-inflammatory and immunoregulatory cytokine involved in the pathogenesis of several autoimmune disorders. Etanercept, a TNF-α antagonist (anti-TNF-α) acting as a soluble TNF-α receptor, has been associated with neurological demyelinating disorders. This paper aims to report an unusual case showing tumefactive central nervous system (CNS) inflammatory demyelination in a patient in the course of TNF -α antagonist therapy, requiring decompressive hemicraniectomy. This report is based on magnetic resonance imaging (MRI) findings and histology. A biopsy confirmed the inflammatory demyelinating nature of the lesions. The clinical presentation is unusual due to the severity of the disease process, requiring decompressive hemicraniotomy with a clinically favorable outcome.
Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland.
C W
CW
Cereda
C
C
Zecca
L
L
Mazzucchelli
L
L
Valci
C
C
Staedler
C L
CL
Bassetti
C
C
Gobbi
D000328:Adult; D001706:Biopsy; D056424:Decompressive Craniectomy / Q000379:methods*; D003711:Demyelinating Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology / Q000601:surgery*; D004660:Encephalitis / Q000139:chemically induced / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology / Q000601:surgery*; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D018124:Receptors, Tumor Necrosis Factor; D020127:Recovery of Function; D013167:Spondylitis, Ankylosing / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology
D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept