SHM Converge Scientific Abstract ePoster Gallery-Guillain-Barre Syndrome in a Crohn's Disease Patient Treated With Tumor Necrosis Factor Inhibitors

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This case report describes a 66-year-old woman with severe Crohn’s disease and stage IV chronic kidney disease who developed Guillain-Barré syndrome (GBS) while receiving infliximab, a tumor necrosis factor (TNF) inhibitor. She had a long Crohn’s history, including a prior hemicolectomy and ileostomy, and had recently been treated with high-dose steroids followed by infliximab for a flare involving interstitial lung disease and diversion colitis.<br /><br />She presented with two days of acute numbness and tingling in both hands and feet, along with progressive symmetric weakness and areflexia in the lower extremities. Neurologic exam showed marked proximal and distal weakness, but cranial nerve function was intact. Laboratory evaluation excluded common alternative causes of neuropathy, including vitamin deficiencies, thyroid disease, infection, and autoimmune antibody-related neuropathies. Electromyography demonstrated an acute sensorimotor axonal neuropathy consistent with GBS. Ganglioside, MAG, and sulfatide antibodies were negative.<br /><br />She was treated with five days of intravenous immunoglobulin (IVIG) and improved significantly. The team planned follow-up to discuss stopping anti-TNF therapy. The report emphasizes that although demyelinating complications are recognized with anti-TNF agents, GBS is a rarer but serious adverse event. The proposed mechanism includes immune dysregulation or unmasking of latent infections that may trigger GBS through molecular mimicry.<br /><br />The authors conclude that clinicians should suspect GBS in patients on anti-TNF therapy who develop sensory symptoms, weakness, areflexia, or ataxia. Early neurologic evaluation, prompt IVIG treatment, and discontinuation of the TNF inhibitor are recommended to prevent lasting disability.

Asset Subtitle

Elona Poltiyelova

Meta Tag

Author List Elona Poltiyelova, Jin Li, Maxwell Charlat, Terry Park, Wei Tang

Category Clinical Vignettes

Concept Guillain-Barré Syndrome

Concept TNF-alpha Inhibitor Therapy

Concept Ascending Weakness

Concept Areflexia

Concept Infliximab

Distinguished Non-Finalist

Presenter Organization Westchester Medical Center

Presenting Author Elona Poltiyelova

Track Adult

Keywords

Guillain-Barré syndrome

infliximab

Crohn’s disease

TNF inhibitor

acute sensorimotor axonal neuropathy

intravenous immunoglobulin

areflexia

demyelinating complications

anti-TNF therapy

neuropathy

Guillain-Barré Syndrome

TNF-alpha Inhibitor Therapy

Ascending Weakness

Areflexia

Infliximab