Pathological Findings in Central Nervous System Demyelination Associated with Infliximab

BACKGROUND:Tumor necrosis factor alpha (TNF-alpha) inhibitors, such as infliximab, are commonly used to treat rheumatoid arthritis (RA) and other immune-mediated disorders.OBJECTIVE:To determine whether infliximab-associated central nervous system (CNS) demyelination can be differentiated from multiple sclerosis (MS).METHODS:We present a case of pathologically proven CNS demyelination in a patient treated with infliximab and describe clinical-radiographic-neuropathological findings. Putative mechanisms of TNF-alpha inhibitor-associated CNS demyelination are described.RESULTS AND CONCLUSION:Infliximab treatment is associated with CNS inflammatory demyelinating activity, which is histopathologically indistinguishable from MS.