Multifocal Motor Neuropathy with Conduction Blocks During TNF-alpha Antagonist Therapy in a Patient with Spondyloarthropathy

Rul Bin Kim; Dong Hoon Kang; Sung Yeon Lee; Ji Suk Han; Soo Kyung Lim; Su Hee Song; Young-Il Seo; Hyun Ah Kim

doi:10.4078/jrd.2013.20.3.177

Journal List > J Rheum Dis > v.20(3) > 1064039

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Kim, Kang, Lee, Han, Lim, Song, Seo, and Kim: Multifocal Motor Neuropathy with Conduction Blocks During TNF-alpha Antagonist Therapy in a Patient with Spondyloarthropathy

Case Report

J Rheum Dis 2013;20(3):177-180.

Published online: 31 June 2013

DOI: https://doi.org/10.4078/jrd.2013.20.3.177

Multifocal Motor Neuropathy with Conduction Blocks During TNF-alpha Antagonist Therapy in a Patient with Spondyloarthropathy

Rul Bin Kim, Dong Hoon Kang, Sung Yeon Lee, Ji Suk Han, Soo Kyung Lim, Su Hee Song, Young-Il Seo, Hyun Ah Kim

Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea

Corresponding to : Hyun Ah Kim, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896, Dyongchon-dong, Dongan-gu, Anyang 431-070, Korea. E-mail : Kimha@hallym.ac.kr

Received 9 May 201231 May 2012 Accepted 2 June 2012

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Tumor necrosis factor (TNF)-alpha antagonist has been proven to have benefit for rheumatologic diseases. Because TNF-alpha is not only an important mediator of inflammation in human body, but plays many physiologic roles, it can cause unique adverse effects or complications related to these functions. Adverse effects involving neurological systems, such as Guillain-Barre syndrome, Chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy with conduction blocks (MMNCB), distal symmetric polyneuropathy, and small fibers neuropathy have been previously reported. However, only several cases of infliximab-associated MMNCB are reported. We report a case of MMNCB which developed while treating spondyloarthropathy with infliximab.

Keywords: Infliximab, TNF-alpha antagonist, Multifocal motor neuropathy with conduction blocks

References

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Figure 1.

Serial motor nerve conduction studies of the right median nerve and left radial nerve among the 4 months. (A, B) The first study was done at 14 days after symptom onset, muscle response after stimu-lation at the axilla is 50% reduced in amplitude and area as compared with that after more distal stimu-lation at the forearm. This fits the definition of focal motor conduction block across that nerve segment. (C, D) Four months after stopping infliximab, the conduction blocks had slightly improved in the right median nerve and left radial nerve. APB: abductor pollicis brevis, EIP: extensor indicis proprius.

Table 1.

Nerve conduction study in the patient

Motor (R/L)	Terminal latency (ms)	Amplitude (mV)	Conduction velocity (m/s)	F-latency (ms)
Median (APB)
Wrist	2.8/2.7	10/12		24.3/UC
Elbow	6.7/6.6	2.3/12	56.4/54.9
Axillary	8.6/7.5	2.1/1.4	61.6/36.8
Erb's	UC/9.55
Ulnar (ADM)
Wrist	2.1/2.1	10.1/10.9		24.6/27.1
B.Elbow	5.7/5.6	9/8.7	54.7/59.2
A.Elbow	7.3/7.4	9/7.4	65.2/52.8
Axillary	9.5/8.2	9/7.4	61.2/69.3
Radial (EIP)
Forearm	1.5/1.4	3.5/3.8
Elbow	4.9/4.6	3.3/0.8	71.6/69.8

R/L: right/left, F-latency: F-wave, APB: abductor pollicis brevis, ADM: abductor digiti/minimi, EIP: extensor indicis proprius, UC: unchecked, B.Elbow: below elbow, A.Elbow: above elbow.

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