Motor neuropathy with multiple conduction blocks associated with TNF-alpha antagonist.

Professor da Disciplina de Neurologia e Neurocirurgia do Curso de Medicina da Universidade Estadual do Oeste do Paraná UNIOESTE, Paraná, Brasil; Professor da Disciplina de Clínica Cirúrgica do Curso de Medicina da Universidade Estadual do Oeste do Paraná UNIOESTE, Paraná, Brasil; Chefe do Serviço de Coloproctologia do Hospital Universitário Cajuru PUCPR, Paraná, Brasil. Infliximab, eternecept and adalimumab are tumour necrosis alpha factor (TNFalpha) antagonists which recently became part of several auto-immune diseases therapeutic arsenal, mainly in rheumatoid arthritis, ankylosing spondilitis, psoriatic arthritis, as well as inflammatory bowel diseases. TNF-alpha plays a crucial role in many aspects of immune system development, immune-response regulation and T-cell-mediated tissue injury. It is a cytokine with both pro-inflammatory and immunoregulatory properties and is involved in normal inflammation and immune responses. TNF-alpha is an important growth factor for prothymocytes and thimocytes, and thereby influences the generation of the T-cell repertoire. In the peripheral immune system, TNF-alpha participates in antigen-presenting cellfunction and in regulating apoptosis of potentially auto-reactive Tcells. So that, immunological complications with drugs that antagonize TNF-alpha receptors were expected to occur. Demyelinating peripheral motor neuropathy is one of them, but it is relatively uncommon. We report a patient who had a severe form of Crohn’s disease, who developed a peripheral neuropathy with multiple motor conduction blocks at atypical sites, with axonal damage signs, probably associated with infliximab treatment.