Anti-tumor necrosis factor alpha-associated multiple sclerosis

Abstract

A case of multiple sclerosis presenting during anti-tumor necrosis factor treatment for rheumatoid arthritis is discussed. This association has been reported in the nonradiological literature, but is an important association for radiologists to be aware of, as they may be in a position to first suggest the diagnosis.

Fig 1.

A 33-year-old woman with longstanding RA on etanercept treatment, presenting with neurologic symptoms including body numbness and L’Hermitte sign. A, Sagittal T2-weighted fat suppressed image of the left ankle shows severe peroneal tenosynovitis from the patient’s known RA. B and C, Axial brain images from fluid-attenuated inversion recovery sequence reveal multifocal white matter lesions. D, Midline sagittal proton attenuation weighted image of the cervical spine reveals large demyelinating lesions at the C2 and C5 levels.

Fig 2.

One year after discontinuation of etanercept, the patient developed new diplopia, gaze deficit, and left cranial nerve III palsy. Shown is an axial T2-weighted image at level of the midbrain, revealing a demyelinating lesion centered in the left periaqueductal region, in proximity to the oculomotor nucleus.