Glial Fibrillary Acidic Protein (GFAP) Autoimmunity in the Setting of Seropositive Rheumatoid Arthritis Treated With Etanercept.
Smith, Kelsey M. MD *; Amin, Shreyasee MD, CM, MPH +; Jones, Lyell K. Jr MD *; Lachance, Daniel H. MD *; Flanagan, Eoin P. MBBCh *; Jentoft, Mark E. MD ++; Kantarci, Orhun H. MD *
[Report] Neurologist. 24(5):152-154, September 2019.

(Format: HTML, PDF)

Introduction: Glial fibrillary acidic protein (GFAP) immunoglobulin G is a recently discovered biomarker of an autoimmune central nervous system disorder characterized by a steroid-responsive meningoencephalomyelitis.

Case Report: A 63-year-old man with rheumatoid arthritis on etanercept presented with steroid-responsive subacute encephalopathy and foot drop. Brain and sural nerve biopsies demonstrated a T-cell perivascular infiltrate. Cerebrospinal fluid studies 18 months into the course of the illness demonstrated a GFAP antibody on mouse tissue immunofluorescence confirmed by cell-based assay. The patient was treated with steroids and cyclophosphamide leading to resolution of his symptoms.

Conclusion: This case expands on the previously reported cases of GFAP immunoglobulin G autoimmunity by describing an associated inflammatory large fiber peripheral neuropathy.

Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved.