PMID- 26847675
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20160205
LR  - 20200930
IS  - 2193-8253 (Print)
IS  - 2193-6536 (Electronic)
IS  - 2193-6536 (Linking)
VI  - 4
IP  - 1
DP  - 2015 Jun
TI  - Peculiar Cytological Cerebrospinal Fluid Pattern in a Case of Encephalomyelitis 
      During Anti-Tumor Necrosis Factor-alpha Therapy.
PG  - 53-60
LID - 10.1007/s40120-015-0027-z [doi]
AB  - INTRODUCTION: Tumor necrosis factor-alpha (TNF-alpha) blocking agents may be associated 
      with neurological adverse events, including demyelinating syndromes, that can be 
      difficult to differentiate from multiple sclerosis (MS) and clinically isolated 
      syndrome (CIS) as neither the clinical nor laboratory distinctive features have 
      been reported. Usually clinicians mainly examine the diagnostic value of 
      immunoglobulin G oligoclonal bands underestimating the value of other 
      cerebrospinal fluid (CSF) parameters (such as CSF cytology). CASE REPORT: We 
      present a case of a patient who acutely developed mild pyramidal and sensory 
      impairment of lower limbs and urinary hesitancy during treatment with adalimumab, 
      a monoclonal antibody to TNF-alpha, for psoriatic arthritis. Magnetic resonance 
      imaging demonstrated a widespread area of hyperintense signal extending from C5 
      to D8 level in T2-weighted images. Two consecutive CSF examinations showed an 
      intense activation of monocyte/macrophage lineage (88% and 90%, respectively) 
      with some giant and binucleated cells that notably decreased five months after 
      TNF-alpha blocker cessation. We compared the results of CSF examinations of our 
      patient with CSF results of 20 patients with MS and 20 patients with CIS that 
      demonstrated activation of both lymphocytic and monocytic lineage (MS: 48% and 
      52%, respectively, CIS: 54.5% and 43.5%, respectively) that were very different 
      from the findings in adalimumab-related encephalomyelitis in acute phase (11% and 
      89%, respectively). CSF cytology in two patients with neuromyelitis optica during 
      the relapse (n = 3) showed minor monocyte/macrophage activation (9%) and an 
      increased number of granulocytes (77%). CONCLUSION: Prominent activation of 
      monocyte/macrophage lineage with some binucleated giant cells in CSF could be 
      induced by anti-TNF-alpha treatment. The peculiar CSF pattern, never found in MS, 
      CIS, and NMO, can help in differential diagnosis and stresses the importance of 
      careful CSF cytology evaluation in the course of demyelinating diseases.
FAU - Motuzova, Yana
AU  - Motuzova Y
AD  - Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San 
      Luigi, Orbassano, Italy. ymotuzova@gmail.com.
FAU - Di Sapio, Alessia
AU  - Di Sapio A
AD  - Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San 
      Luigi, Orbassano, Italy.
FAU - Capobianco, Marco
AU  - Capobianco M
AD  - Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San 
      Luigi, Orbassano, Italy.
FAU - Sala, Arianna
AU  - Sala A
AD  - Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San 
      Luigi, Orbassano, Italy.
FAU - Marnetto, Fabiana
AU  - Marnetto F
AD  - Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San 
      Luigi, Orbassano, Italy.
FAU - Malucchi, Simona
AU  - Malucchi S
AD  - Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San 
      Luigi, Orbassano, Italy.
FAU - Bertolotto, Antonio
AU  - Bertolotto A
AD  - Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San 
      Luigi, Orbassano, Italy.
LA  - eng
PT  - Journal Article
DEP - 20150306
PL  - New Zealand
TA  - Neurol Ther
JT  - Neurology and therapy
JID - 101637818
PMC - PMC4470972
OTO - NOTNLM
OT  - Adalimumab
OT  - Cerebrospinal fluid
OT  - Clinically isolated syndrome
OT  - Encephalomyelitis
OT  - Multiple sclerosis
OT  - Neuromyelitis optica
OT  - Psoriatic arthritis
OT  - TNF-alpha blocking agents
EDAT- 2016/02/06 06:00
MHDA- 2016/02/06 06:01
PMCR- 2015/03/06
CRDT- 2016/02/06 06:00
PHST- 2014/10/27 00:00 [received]
PHST- 2016/02/06 06:00 [entrez]
PHST- 2016/02/06 06:00 [pubmed]
PHST- 2016/02/06 06:01 [medline]
PHST- 2015/03/06 00:00 [pmc-release]
AID - 10.1007/s40120-015-0027-z [pii]
AID - 27 [pii]
AID - 10.1007/s40120-015-0027-z [doi]
PST - ppublish
SO  - Neurol Ther. 2015 Jun;4(1):53-60. doi: 10.1007/s40120-015-0027-z. Epub 2015 Mar 
      6.