Adalimumab-induced sensory vasculitic neuropathy. Issue 1 (17th January 2022)

• Record Type: Journal Article
• Authors: Sim, Nicholas Keyi; Ismail, Azzam; Alam, Taimour; Shanmugarajah, Priya Devi
• Is Part Of: BMJ case reports. Volume 15:Issue 1(2022)
• Publication Date: 2022-01-17
• Subjects: clinical neurophysiology -- peripheral nerve disease -- unwanted effects / adverse reactions -- biological agents -- vasculitis; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2021-246401
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : Vasculitis and other autoimmune conditions are known complications of tumour necrosis factor alpha (TNF-α) inhibitor use. By definition, TNF-α inhibitor induced vasculitis is a secondary systemic vasculitis. However, its phenotype is varied and can present as an isolated vasculitic neuropathy. This presents a diagnostic challenge as the gold standard for diagnosis of a vasculitic neuropathy is a peripheral nerve biopsy that meets predefined histopathological criteria. Given the poor sensitivity of the peripheral nerve biopsy, it is important that clinicians take a good history and maintain a high index of suspicion, as this is a treatable iatrogenic condition. Here we present a case of adalimumab-induced sensory vasculitic neuropathy, treated according to the Peripheral Nerve Society guideline for non-systemic vasculitic neuropathy, given her disease phenotype.