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Case report
Adalimumab-induced sensory vasculitic neuropathy
  1. Nicholas Keyi Sim1,
  2. Azzam Ismail2,
  3. Taimour Alam3 and
  4. Priya Devi Shanmugarajah4
  1. 1Department of Neurology, Calderdale and Huddersfield NHS Foundation Trust, Halifax, UK
  2. 2Department of Pathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  3. 3Department of Clinical Neurophysiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  4. 4Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  1. Correspondence to Dr Nicholas Keyi Sim; nicholas.sim1{at}nhs.net

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.

  • clinical neurophysiology
  • peripheral nerve disease
  • unwanted effects / adverse reactions
  • biological agents
  • vasculitis

https://doi.org/10.1136/bcr-2021-246401

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    Footnotes

    • Twitter @azzam9963

    • Contributors NS drafted the manuscript, edited the figures and tables, and edited the final manuscript. AI prepared the figure and highlights, and drafted the pathology sections of the manuscript and figure legend. TA prepared the neurophysiology tables. PS conceptualised the manuscript and made significant revisions. All authors commented on the final version of the manuscript and approved it for publication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.