Chronic Inflammatory Demyelinating Polyneuropathy in Patients With Crohn's Disease on Infliximab Therapy

Abstract

Crohn's disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract that is frequently accompanied by systemic complications including peripheral neuropathies. Anti-tumor necrosis factor-alpha agents such as infliximab are an established treatment for immune-mediated diseases. However, they have been associated with adverse effects, including local reactions, infections, congestive heart failure, malignancies, and, rarely, they can cause neurological adverse effects on the central nervous system, as well as peripheral nervous system demyelination. Here, we report the case of an 80-year-old man with CD on infliximab therapy who presented with progressive weakness and numbness. A neurological examination and a nerve conduction study suggested chronic inflammatory demyelinating polyneuropathy (CIDP). The patient was started on oral corticosteroids and experienced transient improvement of his symptoms at the end of this course. Thus, CIDP could be one of the extraintestinal presentations of CD.

Keywords: anti-tnf-α treatment; chronic inflammatory demyelinating polyradiculoneuropathy; crohn’s disease; infliximab; neurological complications.

Figure 1. Right median nerve motor conduction showing reduced amplitude and conduction velocity with marked temporal dispersion.

NCV: nerve conduction velocity

Figure 2. Right ulnar nerve motor conduction showing reduced amplitude and conduction velocity with marked temporal dispersion.

NCV: nerve conduction velocity

Figure 3. A timeline of the clinical events.

NCS: nerve conduction study; EMG: electromyography