title: Multifocal Motor Neuropathy Associated with Infliximab.
abstract: BACKGROUND
  The anti-tumour necrosis factor [TNF] monoclonal antibody, infliximab, is commonly prescribed in both ulcerative colitis and Crohn's disease. Neurological side effects such as optic neuritis are well recognised, although not as frequently seen as hypersensitivity and serious infections.
  
  
  METHODS
  We present a case of peripheral neuropathy in a young man on infliximab therapy for ulcerative colitis. This presented as an asymmetrical and slowly progressive weakness in his right upper limb, severely impacting on function. Investigations confirmed a diagnosis of multifocal motor neuropathy [MMN]. This has been previously described in patients receiving infliximab for rheumatological conditions. The exact mechanism is unclear, but the neuropathy responds well to intravenous immunoglobulin. In our case, infliximab was discontinued. The patient was treated with immunoglobin for 5 days and recovered rapidly. Mercaptopurine was instituted as maintanence therapy, with good effect.
  
  
  CONCLUSIONS
  Gastroenterologists prescribing infliximab should be cognisant of both peripheral and central neurological complications, ensuring prompt withdrawal of the offending agent and appropriate alternative treatment.
authors.affiliation: Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland and School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. c.rowan2@st-vincents.ie.
authors.forename: Catherine R
authors.initials: CR
authors.lastname: Rowan
authors.affiliation: Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland and School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
authors.forename: Niall
authors.initials: N
authors.lastname: Tubridy
authors.affiliation: Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland and School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
authors.forename: Garret
authors.initials: G
authors.lastname: Cullen
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D000069285:Infliximab / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D020423:Median Neuropathy / Q000139:chemically induced* / Q000175:diagnosis; D011115:Polyneuropathies / Q000139:chemically induced* / Q000175:diagnosis; D020425:Radial Neuropathy / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D005765:Gastrointestinal Agents; D000069285:Infliximab
keywords: Infliximab; motor neuropathy