2 Department of Neurology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul
3 Department of Pediatrics, Division of Pediatric Rheumatology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Türkiye DOI : 10.24953/turkjped.2021.4573 Background. Chronic inflammatory demyelinating neuropathy has been reported after the use of tumor necrosis factor inhibitors. The mechanisms of nerve injury caused by tumor necrosis factor inhibitors are not yet well understood.
Case. In this paper, we report a 12 year and nine month old girl who developed chronic inflammatory demyelinating neuropathy in the course of juvenile idiopathic arthritis after etanercept withdrawal. She became non-ambulant with four-limb involvement. She received intravenous immunoglobulins, steroids, and plasma exchange, but had a limited response. Finally, rituximab was given and a slow, but progressive clinical improvement was seen. She was ambulant four months after rituximab treatment. We considered chronic inflammatory demyelinating neuropathy as a probable adverse effect of etanercept.
Conclusions. Tumor necrosis factor inhibitors could elicit the demyelinating process, and chronic inflammatory demyelinating neuropathy might persist despite treatment discontinuation. First-line immunotherapy may be inefficient as in our case, and aggressive treatment may be necessary.
Keywords : tumor necrosis factor inhibitors, etanercept, chronic inflammatory demyelinating neuropathy, adverse drug reaction