Successful treatment of refractory neuro-Behcet's disease with infliximab: a case report to show its efficacy by magnetic resonance imaging, transcranial magnetic stimulation and cytokine profile.

摘要

Involvement of the central nervous system' is one of the most devastating manifestations of Behc,et's disease. We describe a patient with refractory neuro-Behc.et's disease, successfully treated by infliximab, a chimeric monoclonal antibody to tumour necrosis factor a (TNFalpha). A 36-year-old Japanese woman, already diagnosed as having Behget's disease on the basis of recurrent appearance of orogenital ulcers and bilateral uveitis, was referred to the First Department of Internal Medicine, Graduate School of Biochemical Sciences, Nagashaki University Hospital. On admission, neurological examinations showed cerebellar ataxia and pyramidal tract involvement. Examination of the patient's cerebrospinal fluid (CSF) showed a total cell count of 576/mm~3 with 56% neutrophils; protein was 128 mg/dl. A conventional therapeutic regimen, including intravenous methylpredniso-lone and cyclophosphamide and oral methotrexate, was used; however, she did not respond well, and had sudden-onset left hemiplegia. Axial magnetic resonance fluid attenuated inversion recovery images showed a high signal intensity lesion in the right pons, and a Tl-weighted image showed ring-like enhancement.