虽然中枢神经系统脱髓鞘病变作为肿瘤坏死因子(TNF)-α抑制剂的副作用已被报道,这种疗法仍用于一些自身免疫性疾病。
■一名34岁的叙利亚男性表现出行走困难和刺痛,在接下来的4天里,他的身体左侧麻木,在戈利木单抗治疗期间。在过去的两个月里,疲劳,反复的小腿痉挛,发现四肢麻木。神经系统检查发现下肢感觉障碍和反射过度。MRI显示变异型脱髓鞘病变。开始类固醇治疗,戈利木单抗被停用,随着症状消失,结果良好。
■抗TNF治疗后脱髓鞘的发生率并不常见。大多数研究报道,抗TNFα抑制剂治疗和脱髓鞘病变存在之间的平均时间为5个月至4年,即使在停止抗TNFα抑制剂后,这些病变也可能出现;同时,在我们的病例中,治疗停止后症状完全治愈,这表明了因果关系,虽然是一种时间关系,在这种情况下,不能建立。作者认为戈利木单抗在脱髓鞘病变的发展中起作用,尽管它可能是Behcet病过程中的临床表现。
■应注意戈利木单抗治疗的副作用,如脱髓鞘病变,需要对Bechet病患者进行长期监测。
Although central nervous system demyelinating lesions as a side effect of tumor necrosis factor (TNF)-alpha inhibitors have been reported, this treatment is still used in some autoimmune diseases.
UNASSIGNED: A 34-year-old Syrian male presented with difficulty walking and tingling, and numbness on the left side of his body over the next 4 days, during
golimumab treatment. Over the past 2 months, fatigue, recurrent calf spasms, and extremity numbness were found. Sense disturbance and hyper-reflexes of the lower extremities were found on neurological examination. MRI demonstrated variant demyelinating lesions. Steroid therapy was initiated, and
golimumab was discontinued, with good outcomes as the symptoms have disappeared.
UNASSIGNED: The incidence of demyelination following anti-TNF therapy is uncommon. Most studies have reported that the average time between the anti-TNFα inhibitor treatment and the demyelinating lesion presence is from 5 months to 4 years, and these lesions may appear even after the cessation of the anti-TNFα inhibitor; meanwhile, a total cure of the symptoms after treatment cessation happened in our
case, which suggests a causal relation, although a temporal relationship, in this
case, cannot be established. The authors believe that
golimumab plays a role in the demyelinating lesions development, although it may be a clinical manifestation during the course of Behcet\'s disease.
UNASSIGNED: Caution should be taken for the side effects of Golimumab treatment, such as demyelinating lesions, and long-term monitoring of patients with Bechet disease is required.