Patwala Kurvi, Crump Nicholas, De Cruz Peter
Department of Gastroenterology, Austin Health, Heidelberg, Australia.
Department of Neurology, Austin Health, Heidelberg, Australia.
BMJ Case Rep. 2017 Jul 5;2017:bcr-2017-219481. doi: 10.1136/bcr-2017-219481.
Guillain-Barré syndrome (GBS) is an immune-mediated disease characterised by evolving ascending limb weakness, sensory loss and areflexia. Two-thirds of GBS cases are associated with preceding infection. However, GBS has also been described in association with antitumour necrosis factor (TNF) therapies including infliximab and adalimumab for chronic inflammatory disorders such as rheumatoid arthritis, ankylosing spondylitis and inflammatory bowel disease. We present the case of a patient who developed GBS while undergoing treatment with adalimumab in combination with azathioprine for severe fistulising Crohn's disease, and review the literature on neurological adverse events that occur in association with anti-TNF therapy. We also propose an approach to the optimal management of patients who develop debilitating neurological sequelae in the setting of anti-TNF therapy.
吉兰-巴雷综合征（GBS）是一种免疫介导性疾病，其特征为进行性上升性肢体无力、感觉丧失和腱反射消失。三分之二的GBS病例与先前感染有关。然而，GBS也被描述与抗肿瘤坏死因子（TNF）治疗相关，包括用于类风湿关节炎、强直性脊柱炎和炎症性肠病等慢性炎症性疾病的英夫利昔单抗和阿达木单抗。我们报告了一例在接受阿达木单抗联合硫唑嘌呤治疗严重瘘管性克罗恩病时发生GBS的患者病例，并回顾了与抗TNF治疗相关的神经系统不良事件的文献。我们还提出了一种针对在抗TNF治疗过程中出现致残性神经后遗症患者的最佳管理方法。
