Guillain–Barre in a patient with ankylosing spondylitis secondary to ulcerative colitis on infliximab therapy

We describe a 47-year-old woman with severe spondylarthropathy secondary to ulcerative colitis who developed a Guillain–Barre after the use of anti-TNF-α. She first developed ulcerative colitis in November 1997. In 2003, she developed uveitis and, in 2005, axial and enthesitis form of spondylarthropathy. In May 2007, her condition was exacerbated. Therapy with infliximab has been initiated. The patient received 5-mg/kg infusions of infliximab. She had significant improvement in her arthritis and was in remission for her ulcerative colitis. She was admitted to the hospital 2 weeks after her third dose of infliximab for having developed paraesthesia of her hands and lower limbs. Neurophysiology studies demonstrated an acquired segmental demyelinating polyneuropathy consistent with Guillain–Barre syndrome (GBS). Laboratory investigations were unremarkable. She was treated with intravenous corticosteroids with no improvement. After this, she received infusions of intravenous gammaglobulin (IVIg) with complete recovery of the muscle strength within a few weeks. A follow-up electromyographic study 3 months later showed normal finding. The development of GBS in our patient may be secondary to her anti-TNF-α treatment. At present, she remains off anti-TNF-α therapy.