BACKGROUND: adalimumab, a human recombinant monoclonal antibody against tumoral necrosis factor alpha (TNFα), has been associated with central nervous system demyelinating diseases and peripheral neuropathic syndrome. The Guillain-Barré Syndrome (GBS) is one of them. CLINICAL CASE: we presented the case of a 65 year old woman, with diabetes mellitus and psoriasic arthritis, treated with adalimumab; after the fourth infusion, she developed paresthesia and mild weakness in lower limbs, these symptoms persisted three days after each infusion and each time remitted spontaneously; following the eight dose, presented a characteristic clinical picture of the GBS, confirmed with neurophysiological studies that showed an axonal motor-sensitive polyneuropathy. The treatment consisted in intravenous immunoglobulin, with good outcome. CONCLUSIONS: the synergy among cellular and humoral immune responses, against peripheral nerve antigens is responsible of immunopathogenesis related to GBS. The prolonged and intensified pathologic immune response induced by adalimumab, may be associated to the development of GBS.
BACKGROUND:adalimumab, a human recombinant monoclonal antibody against tumoral necrosis factor alpha (TNFα), has been associated with central nervous system demyelinating diseases and peripheral neuropathic syndrome. The Guillain-Barré Syndrome (GBS) is one of them. CLINICAL CASE: we presented the case of a 65 year old woman, with diabetes mellitus and psoriasic arthritis, treated with adalimumab; after the fourth infusion, she developed paresthesia and mild weakness in lower limbs, these symptoms persisted three days after each infusion and each time remitted spontaneously; following the eight dose, presented a characteristic clinical picture of the GBS, confirmed with neurophysiological studies that showed an axonal motor-sensitive polyneuropathy. The treatment consisted in intravenous immunoglobulin, with good outcome. CONCLUSIONS: the synergy among cellular and humoral immune responses, against peripheral nerve antigens is responsible of immunopathogenesis related to GBS. The prolonged and intensified pathologic immune response induced by adalimumab, may be associated to the development of GBS.