依那西普治疗青少年特发性关节炎后慢性炎性脱髓鞘神经病变。

IF 0.8 4区 医学 Q4 PEDIATRICS Turkish Journal of Pediatrics Pub Date : 2023-01-01 DOI:10.24953/turkjped.2021.4573
Hülya Maraş Genç, Büşra Kutlubay, Reyhan Sürmeli, Hatice Gülhan Sözen, Betül Sözeri
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引用次数: 1

摘要

背景:使用肿瘤坏死因子抑制剂后,有慢性炎症性脱髓鞘神经病变的报道。肿瘤坏死因子抑制剂引起神经损伤的机制尚不清楚。病例:在本文中,我们报告了一名12岁零9个月的女孩,她在少年特发性关节炎停药后出现慢性炎症性脱髓鞘神经病变。她四肢受累,不能走动。她接受了静脉注射免疫球蛋白、类固醇和血浆置换,但反应有限。最后,给予利妥昔单抗治疗,临床改善缓慢但渐进。利妥昔单抗治疗4个月后可走动。我们认为慢性炎症性脱髓鞘神经病变可能是依那西普的不良反应。结论:肿瘤坏死因子抑制剂可引起脱髓鞘过程,慢性炎症性脱髓鞘神经病变可能持续存在,尽管停止治疗。像我们的病例一样,一线免疫治疗可能是无效的,而积极的治疗可能是必要的。
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Chronic inflammatory demyelinating neuropathy after etanercept therapy in the course of juvenile idiopathic arthritis.

Background: Chronic inflammatory demyelinating neuropathy has been reported after the use of tumor necrosis factor inhibitors. The mechanisms of nerve injury caused by tumor necrosis factor inhibitors are not yet well understood.

Case: In this paper, we report a 12 year and nine month old girl who developed chronic inflammatory demyelinating neuropathy in the course of juvenile idiopathic arthritis after etanercept withdrawal. She became non-ambulant with four-limb involvement. She received intravenous immunoglobulins, steroids, and plasma exchange, but had a limited response. Finally, rituximab was given and a slow, but progressive clinical improvement was seen. She was ambulant four months after rituximab treatment. We considered chronic inflammatory demyelinating neuropathy as a probable adverse effect of etanercept.

Conclusions: Tumor necrosis factor inhibitors could elicit the demyelinating process, and chronic inflammatory demyelinating neuropathy might persist despite treatment discontinuation. First-line immunotherapy may be inefficient as in our case, and aggressive treatment may be necessary.

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来源期刊
CiteScore
1.40
自引率
0.00%
发文量
122
审稿时长
6-12 weeks
期刊介绍: The Turkish Journal of Pediatrics is a multidisciplinary, peer reviewed, open access journal that seeks to publish research to advance the field of Pediatrics. The Journal publishes original articles, case reports, review of the literature, short communications, clinicopathological exercises and letter to the editor in the field of pediatrics. Articles published in this journal are evaluated in an independent and unbiased, double blinded peer-reviewed fashion by an advisory committee.
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