Guillain-Barré syndrome in association with antitumour necrosis factor therapy: a case of mistaken identity

BMJ Case Rep. 2017 Jul 5;2017:bcr2017219481. doi: 10.1136/bcr-2017-219481.


Guillain-Barré syndrome (GBS) is an immune-mediated disease characterised by evolving ascending limb weakness, sensory loss and areflexia. Two-thirds of GBS cases are associated with preceding infection. However, GBS has also been described in association with antitumour necrosis factor (TNF) therapies including infliximab and adalimumab for chronic inflammatory disorders such as rheumatoid arthritis, ankylosing spondylitis and inflammatory bowel disease. We present the case of a patient who developed GBS while undergoing treatment with adalimumab in combination with azathioprine for severe fistulising Crohn's disease, and review the literature on neurological adverse events that occur in association with anti-TNF therapy. We also propose an approach to the optimal management of patients who develop debilitating neurological sequelae in the setting of anti-TNF therapy.

Keywords: Contraindications and precautions; Drugs: Gastrointestinal system; Inflammatory bowel disease; Neurology (drugs and medicines); Peripheral nerve disease.

Publication types

  • Case Reports

MeSH terms

  • Adalimumab / adverse effects*
  • Adult
  • Anti-Inflammatory Agents / adverse effects*
  • Azathioprine / adverse effects*
  • Crohn Disease / drug therapy*
  • Crohn Disease / metabolism
  • Gastrointestinal Agents / adverse effects
  • Guillain-Barre Syndrome / chemically induced*
  • Guillain-Barre Syndrome / metabolism
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Infliximab / adverse effects
  • Male
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*


  • Anti-Inflammatory Agents
  • Gastrointestinal Agents
  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Adalimumab
  • Azathioprine