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Paraparesis due to exacerbation of preexisting spinal pseudoarthrosis following infliximab therapy for advanced ankylosing spondylitis.

Sakaura H, Hosono N, Mukai Y, Fujii R, Yoshikawa H

Department of Orthopedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan. sakaurah@ort.med.osaka-u.ac.jp

BACKGROUND CONTEXT: Recent reports have described the long-term efficacy and safety of infliximab as a treatment for ankylosing spondylitis (AS). The most important adverse effects of infliximab are infections, malignancies, autoimmunities, and hypersensitivity reactions. There has never been a reported case of paraparesis after infliximab therapy for AS. PURPOSE: To describe a case with paraparesis caused by rapid exacerbation of preexisting spinal pseudoarthrosis after infliximab therapy for advanced AS. STUDY DESIGN/SETTING: Case report/Osaka University Graduate School of Medicine, Suita, Japan. PATIENT SAMPLE: A 55-year-old man with a 27-year history of AS. OUTCOME MEASURES: Case report. METHODS: A 55-year-old man with a 27-year history of AS was treated with infliximab, which provided considerable pain relief and improvement of activities of daily living. However, as the patient resumed vigorous daily activity, he felt back pain and subsequently developed paraparesis. Radiographs showed rapid exacerbation of preexisting spinal pseudoarthrosis at the T11-T12 level after infliximab therapy. RESULTS: After laminectomy and posterolateral fusion, the back pain and paraparesis improved sufficiently to allow independent walking, but moderate bladder dysfunction persisted. CONCLUSIONS: Although this patient could have certainly become myelopathic over time without undergoing infliximab therapy, the patient's history and radiographic course suggest that suppression of inflammation by infliximab improved his activities of daily living, which paradoxically exacerbated preexisting spinal pseudoarthrosis and quickened the onset of subsequent myelopathy.

Published 2 May 2006 in Spine J, 6(3): 325-9.
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