title: Bilateral diaphragmatic paralysis associated with the use of the tumor necrosis factor-alpha inhibitor adalimumab.
abstract: A 51-year-old woman was referred for evaluation of progressive dyspnea of 3 months- duration. She had received 3 doses of adalimumab for treatment of rheumatoid arthritis prior to the onset of her dyspnea. Her chest examination revealed absent diaphragmatic movement with inspiration. Spirometry showed a severe restrictive defect. Radiologic studies confirmed the diagnosis of bilateral diaphragmatic paralysis. Laboratory and radiologic workup excluded other possible causes of the diagnosis. Adalimumab was discontinued, and she was treated with bilevel positive airway pressure ventilation and intravenous immunoglobulin. Three months later, the diaphragmatic paralysis persisted. This is the second reported case of bilateral diaphragmatic paralysis occurring in a patient who had received adalimumab. Acute neuropathies are rare side effects of tumor necrosis factor-alpha inhibitors.
authors.affiliation: Department of Internal Medicine (Benjamin, Rosenblatt) and the Division of Neurology (Martin), Baylor University Medical Center at Dallas.
authors.forename: Mina Mecheal
authors.initials: MM
authors.lastname: Benjamin
authors.affiliation: Department of Internal Medicine (Benjamin, Rosenblatt) and the Division of Neurology (Martin), Baylor University Medical Center at Dallas.
authors.forename: Alan William
authors.initials: AW
authors.lastname: Martin
authors.affiliation: Department of Internal Medicine (Benjamin, Rosenblatt) and the Division of Neurology (Martin), Baylor University Medical Center at Dallas.
authors.forename: Randall Lee
authors.initials: RL
authors.lastname: Rosenblatt