Sakaura Hironobu, Hosono Noboru, Mukai Yoshihiro, Fujii Ryutaro, Yoshikawa Hideki
Department of Orthopedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
Spine J. 2006 May-Jun;6(3):325-9. doi: 10.1016/j.spinee.2005.10.012.
Recent reports have described the long-term efficacy and safety of infliximab as a treatment for ankylosing spondylitis (AS). The most important adverse effects of infliximab are infections, malignancies, autoimmunities, and hypersensitivity reactions. There has never been a reported case of paraparesis after infliximab therapy for AS.
To describe a case with paraparesis caused by rapid exacerbation of preexisting spinal pseudoarthrosis after infliximab therapy for advanced AS.
STUDY DESIGN/SETTING: Case report/Osaka University Graduate School of Medicine, Suita, Japan.
A 55-year-old man with a 27-year history of AS.
Case report.
A 55-year-old man with a 27-year history of AS was treated with infliximab, which provided considerable pain relief and improvement of activities of daily living. However, as the patient resumed vigorous daily activity, he felt back pain and subsequently developed paraparesis. Radiographs showed rapid exacerbation of preexisting spinal pseudoarthrosis at the T11-T12 level after infliximab therapy.
After laminectomy and posterolateral fusion, the back pain and paraparesis improved sufficiently to allow independent walking, but moderate bladder dysfunction persisted.
Although this patient could have certainly become myelopathic over time without undergoing infliximab therapy, the patient's history and radiographic course suggest that suppression of inflammation by infliximab improved his activities of daily living, which paradoxically exacerbated preexisting spinal pseudoarthrosis and quickened the onset of subsequent myelopathy.
近期报道描述了英夫利昔单抗治疗强直性脊柱炎（AS）的长期疗效和安全性。英夫利昔单抗最重要的不良反应是感染、恶性肿瘤、自身免疫反应和过敏反应。既往从未有过英夫利昔单抗治疗AS后发生双下肢轻瘫的病例报道。
描述1例晚期AS患者接受英夫利昔单抗治疗后，原有脊柱假关节迅速加重导致双下肢轻瘫的病例。
研究设计/地点：病例报告/日本大阪大学医学研究生院，吹田市。
1例有27年AS病史的55岁男性。
病例报告。
1例有27年AS病史的55岁男性接受英夫利昔单抗治疗，疼痛明显缓解，日常生活活动能力改善。然而，当患者恢复日常剧烈活动后，出现背痛，随后发展为双下肢轻瘫。影像学检查显示英夫利昔单抗治疗后，原有T11 - T12水平脊柱假关节迅速加重。
行椎板切除及后外侧融合术后，背痛和双下肢轻瘫明显改善，患者能够独立行走，但仍存在中度膀胱功能障碍。
虽然该患者即使未接受英夫利昔单抗治疗，随着时间推移肯定也会发生脊髓病，但患者的病史及影像学病程提示，英夫利昔单抗抑制炎症改善了其日常生活活动能力，却反常地加重了原有的脊柱假关节，并加速了随后脊髓病的发生。
