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• Vol.47 No.2/3
• CLINICA NEUROL, 47: 96−99, 2007
• Vol.47 No.2/3 contents

Case Report

Apperceptive form visual agnosia caused by anti-TNFα therapy to rheumatoid arthritis

Shunsuke Kobayashi, M.D.¹⁾, Makoto Tanno, M.D.²⁾, Ichiro Nakamura, M.D.²⁾, Katsumi Ito, M.D.²⁾ and Yoshikazu Ugawa, M.D.¹⁾

¹⁾Department of Neurology, Tokyo University
²⁾Department of Rheumatology, Yugawara Kosei-Nenkin Hospital

TNFα plays an important role as an inflammatory mediator in both several autoimmune diseases and multiple sclerosis. Anti-TNFα antibody has been widely used to treat rheumatoid arthritis and Crohn's disease. On the other hand, anti-TNFα antibody treatment increased recurrence rate in clinical trials for multiple sclerosis. We report a patient with rheumatoid arthritis without past history of any neurological disorders, who developed diplopia, ataxia, and visual agnosia specific to line drawing in the course of anti-TNFα antibody treatment. MRI studies detected multiple demyelinating lesions in the cerebral white matter and brainstem. The present case indicates that careful observation of neurological symptoms is important in the course of anti-TNFα antibody treatment, even in patients without past history of demyelinating diseases.

(CLINICA NEUROL, 47: 96−99, 2007)
key words: anti TNFα antibody, infliximab, demyelination, rheumatoid arthritis, apperceptive visual agnosia

(Received: 16-Jun-06)