Severe Neuropathy and Tetraparesis Induced by Adalimumab

Abstract

We report a case of severe axonal and demyelinating peripheral polyneuropathy with consecutive tetraparesis following the second application of adalimumab in a 55-year-old man with rheumatoid arthritis. The treatment provided 40 mg of adalimumab s.c. every 2 weeks. Modest muscle pain and weakness followed the first dose, but the second dose resulted in progressive tetraparesis and complete immobility. Electroneurography revealed almost complete denervation of all muscles of the upper extremities, and no motor response at the lower extremities. The finding was suggestive of severe subchronic axonal and demyelinating peripheral polyneuropathy induced by adalimumab. A comprehensive medical work out excluded the possibility of other etiology. At discharge, methylprednisolone was continued for the next 3 months. Nine months of physical rehabilitation and supportive treatment resulted in a modest recovery. Anti-TNF- α agents may induce vasculitis neuropathy at any time during treatment which must be distinguished from the neuropathy of the underlying disease. Appropriate therapy should be initiated immediately and continued long enough. J Neurol Res. 2013;3(2):81-83 doi: https://doi.org/10.4021/jnr189e