SHM Converge Scientific Abstract ePoster Gallery-When Treatment Becomes the Trigger: Adalimumab Induced Isolated Neurosarcoidosis in a Patient With Crohns Disease

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This case describes a 38-year-old woman with Crohn’s disease who developed progressive neurologic symptoms shortly after starting adalimumab, a TNF-alpha inhibitor. Within 16 days of treatment, she experienced diplopia, left leg weakness, and diffuse paresthesias. Initial MRI findings and positive CSF oligoclonal bands raised concern for a demyelinating disorder such as multiple sclerosis.<br /><br />On readmission, further workup showed diffuse pial enhancement involving the brainstem and cranial nerves, with additional cerebellar and cranial nerve enhancement on MRI. These imaging findings were atypical for multiple sclerosis and more suggestive of neurosarcoidosis. Extensive testing for infectious, malignant, and autoimmune causes was negative, and PET/CT showed no evidence of systemic sarcoidosis. A brain biopsy was discussed but deferred.<br /><br />The presumed diagnosis was adalimumab-induced isolated neurosarcoidosis, a paradoxical inflammatory reaction known to occur rarely with TNF-alpha inhibitors. Adalimumab was discontinued. The patient was treated with high-dose intravenous methylprednisolone, and plasma exchange was started because of limited steroid response. Over time, she improved clinically, and follow-up MRI showed resolution of enhancement without new lesions.<br /><br />This case highlights several teaching points: TNF-alpha inhibitors can paradoxically trigger sarcoid-like granulomatous disease; isolated neurosarcoidosis may occur without systemic involvement and can mimic multiple sclerosis; and medication-induced inflammatory syndromes should be considered when new neurologic deficits arise in patients receiving biologic therapy. Early recognition and multidisciplinary management are important to prevent irreversible neurologic injury.

Asset Subtitle

Navjot S. Azad

Meta Tag

Author List Jeremy J. Gentile, Navjot S. Azad, Sonia Gentile

Category Clinical Vignettes

Concept TNF-alpha Inhibitor

Concept Adalimumab

Concept Neurosarcoidosis

Concept Sarcoid-like Granulomatous Disease

Concept High-Dose Corticosteroid

Distinguished Non-Finalist

Presenter Organization Corewell Health – Butterworth Hospital, Grand Rapids, MI

Presenting Author Navjot S. Azad

Track Adult

Keywords

Crohn’s disease

adalimumab

TNF-alpha inhibitor

neurosarcoidosis

demyelinating disorder

multiple sclerosis

cranial nerve enhancement

pial enhancement

plasma exchange

drug-induced inflammation

TNF-alpha Inhibitor

Adalimumab

Neurosarcoidosis

Sarcoid-like Granulomatous Disease

High-Dose Corticosteroid