Bone Marrow Transplant for the Treatment of Multiple Sclerosis Triggered by Anti-TNF Therapy and Crohn‘s Disease
Background:
The use of anti-TNFs carries a low risk of developing demyelinating neuropathy and multiple sclerosis. However, in the event of such occurrences, discontinuing the medication is recommended to prevent the progression of neurological diseases. Autologous bone marrow transplantation has been performed as a treatment of choice for patients with multiple sclerosis for two decades, particularly in refractory cases. More recently, it has also been considered for patients with Crohn‘s disease who show no response to or have contraindications for the use of biological medications. Our study aims to evaluate the efficacy of bone marrow transplantation in halting the progression of both multiple sclerosis and Crohn’s disease simultaneously.
Methods:
Female, 49 years old, diagnosed with Crohn’s disease (A2L3B3p) for the past 28 years. She underwent total proctocolectomy in 2004, she had undergone seven abdominal surgeries due to penetrating disease, involving multiple bowel resections and three anorectal examinations under anesthesia for perineal disease. Commenced infliximab and azathioprine in 2002. In 2008, infliximab was discontinued due to an allergic reaction. In 2013, six months after initiating adalimumab as part of combination therapy, she began experiencing paresthesia in the left lower limb (LLL), which progressed to left upper limb paresis (LUL). Neurological examination revealed muscle strength graded at IV/V in LLL and LUL, hyperreflexia in LUL, and hypoesthesia in LLL.
Results:
Following extensive investigation, including evaluation of the medulla oblongata and central nervous system MRI, with the exclusion of other neurological diseases, the diagnosis of multiple sclerosis triggered by anti-TNF therapy was confirmed, leading to the suspension of medication. High-dose vitamin D was added to the treatment regimen, and immunosuppressants were continued. However, the patient continued to experience acute exacerbations of luminal Crohn‘s disease, necessitating further surgeries due to enteric and enteric cutaneous fistulas, along with worsening paresis in LLL, including gait difficulties. In 2016, with temporary stabilization of abdominal Crohn‘s disease, the patient was referred to a hematology specialist for autologous bone marrow transplantation, which was successfully performed. Currently, the patient remains asymptomatic and has achieved progression-free survival for 7 years.
Conclusions:
Autologous bone marrow transplant emerges as a promising treatment option for patients with severe Crohn‘s disease who develop demyelinating neuropathy due to the use of anti-TNF agents.
