Infliximab-Associated Chronic Inflammatory Central Nervous System Disease and Peroneal Nerve Injury in a Psoriatic Patient Refractory to Treatment: Case Report with 10-Year Follow-Up

Abstract

The tumor necrosis factor-α (TNF-α) antagonists infliximab, adalimumab, and etanercept have been approved for the treatment of chronic inflammatory diseases such as rheumatoid arthritis, ankylosing spondylitis, psoriasis, and psoriatic arthritis. Manifestations of demyelinating disease have been reported for patients receiving TNF-α antagonists. We describe a rare manifestation of a chronic inflammatory process affecting both the central and peripheral nervous system in a patient who received infliximab for the treatment of psoriasis and psoriatic arthritis. Infliximab therapy was discontinued and symptoms improved under high-dose intravenous glucocorticoid pulse therapy.

Keywords: Chronic inflammatory central nervous system disease; Infliximab; Peroneal nerve injury; Treatment-refractory psoriasis.

Fig. 1.

a Sharply delineated erythematosquamous psoriatic plaques of the right leg before infliximab therapy in May 2008. b After the fourth infusion of infliximab at a dose of 5 mg/kg in February 2009, the psoriatic lesions on the right leg had almost disappeared.

Fig. 2.

a, b Magnetic resonance images of the brain in February 2009. T2-weighted images show a lesion in the left peritrigonal region without contrast agent enhancement (arrows) indicative of an inflammatory lesion.