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Issue: Issue 3 (2016) – Supplement 3


Case Report

Multiple sclerosis and inflammatory bowel disease: what implications in therapeutic decisions?

Author(s):
Ana Aires and Pedro Abreu
Abstract:
Introduction: Recent observations suggest an association between Multiple sclerosis (MS) and Inflammatory Bowel Disease (IBD). The anti-TNF-alpha antagonists such as infliximab are an effective therapeutic option in IBD, but may induce worsening of demyelinating diseases. 
Case Report: A 33-year-old Caucasian male with a diagnosis of ulcerative colitis (UC) since 2007 and of relapse-remitting MS since 2004. After MS diagnosis, he started subcutaneous interferon beta-1a thrice a week. No relapses were observed. Six years after diagnosis, the patient developed injection-site reaction and had ulcerative colitis exacerbation. In spite of testing positive for anti-JC virus antibodies, he was medicated with natalizumab (Tysabri®) for two years. After this treatment, in the subsequent three years, by reason of UC worsening, he began azathioprine 150 mg daily. Patient persisted asymptomatic until 2013, when a significant aggravation of UC was detected. Consequently, he started anti-TNF-alpha agent (infliximab), maintaining azathioprine. He had no relapses until the one registered in May 2015. At that time high dose metilprednisolone pulse was initiated and anti-TNF-alpha was interrupted, azathioprine was augmented (200 mg/day) and, later on, the patient started daily subcutaneous glatiramer acetate (Copaxone®). 
Discussion: Our report emphasizes the complexity of treating patients with MS and other autoimmune diseases such as IBD. Despite being very effective in controlling ulcerative colitis, infliximab may worsen MS. The authors discuss what should be the best treatment to control both conditions.

Keywords: Multiple sclerosis, Inflammatory bowel disease, Infliximab.

Special Issue on Inflammatory Demyelinating Diseases of the Central Nervous System

International Journal of Clinical Neurosciences and Mental Health 2016; 3(Suppl. 3):S07
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