Demyelination during anti-tumour necrosis factor therapy for psoriasis

Clinical and Experimental Dermatology
J M E Boggs, L Barnes

Abstract

Anti-tumour necrosis factor (anti-TNF) therapies have been associated with neurological complications, including in rare cases demyelinating disease. It is currently unknown whether patients who have received more than one immunosuppressive agent or anti-TNF have a greater risk of demyelination. We report the case of a 37-year-old woman with psoriasis who presented with an acute episode of demyelination while on anti-TNF therapy. This case was complicated by the fact that progressive multifocal leukoencephalopathy was considered the likely diagnosis initially and was only definitively excluded by brain biopsy. This case demonstrates the difficulty establishing the correct diagnosis in patients with atypical presentations on immunomodulating therapies. We present this rare case of demyelination in a patient who received multiple immunosuppressive therapies to highlight this challenging clinical situation and discuss management with a literature review.

References

Jan 25, 2012·The Journal of Dermatological Treatment·Satveer K MahilCatherine H Smith
Apr 9, 2015·The New England Journal of Medicine·Dennis J NieuwkampUNKNOWN PML in Dutch MS Patients Consortium
Jul 8, 2015·Annals of Neurology·Thorsten BartschIgor J Koralnik
Feb 4, 2016·The Journal of Dermatological Treatment·Tian Hao ZhuTina Bhutani

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Citations

Sep 9, 2020·Expert Opinion on Drug Metabolism & Toxicology·Elisa MolinelliAnnamaria Offidani
Feb 7, 2021·Journal of the European Academy of Dermatology and Venereology : JEADV·A NastC Dressler
Jan 7, 2021·Brain Sciences·Line Buch KristensenHelle H Nielsen

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