Abstract
Tumor necrosis factor alpha (TNF-α) is a pro-inflammatory and immunoregulatory cytokine involved in the pathogenesis of several autoimmune disorders. Etanercept, a TNF-α antagonist (anti-TNF-α) acting as a soluble TNF-α receptor, has been associated with neurological demyelinating disorders. This paper aims to report an unusual case showing tumefactive central nervous system (CNS) inflammatory demyelination in a patient in the course of TNF -α antagonist therapy, requiring decompressive hemicraniectomy. This report is based on magnetic resonance imaging (MRI) findings and histology. A biopsy confirmed the inflammatory demyelinating nature of the lesions. The clinical presentation is unusual due to the severity of the disease process, requiring decompressive hemicraniotomy with a clinically favorable outcome.
Keywords:
CNS demyelinating disease; Marburg’s variant; etanercept; multiple sclerosis.
MeSH terms
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Adult
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Biopsy
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Decompressive Craniectomy / methods*
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Demyelinating Diseases / chemically induced
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Demyelinating Diseases / diagnosis
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Demyelinating Diseases / immunology
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Demyelinating Diseases / physiopathology
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Demyelinating Diseases / surgery*
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Encephalitis / chemically induced
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Encephalitis / diagnosis
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Encephalitis / immunology
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Encephalitis / physiopathology
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Encephalitis / surgery*
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Etanercept
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Humans
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Immunoglobulin G / adverse effects*
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Immunohistochemistry
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Immunosuppressive Agents / adverse effects*
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Magnetic Resonance Imaging
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Male
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Receptors, Tumor Necrosis Factor
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Recovery of Function
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Spondylitis, Ankylosing / diagnosis
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Spondylitis, Ankylosing / drug therapy*
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Spondylitis, Ankylosing / immunology
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Time Factors
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Treatment Outcome
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Tumor Necrosis Factor-alpha / antagonists & inhibitors
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Tumor Necrosis Factor-alpha / immunology
Substances
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Immunoglobulin G
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Immunosuppressive Agents
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Receptors, Tumor Necrosis Factor
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Tumor Necrosis Factor-alpha
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Etanercept