Golimumab therapy-induced isolated myelitis in a Behcet's disease patient: a case report.

Although central nervous system demyelinating lesions as a side effect of tumor necrosis factor (TNF)-alpha inhibitors have been reported, this treatment is still used in some autoimmune diseases. Case Presentation: A 34-year-old Syrian male presented with difficulty walking and tingling, and numbness on the left side of his body over the next 4 days, during golimumab treatment. Over the past 2 months, fatigue, recurrent calf spasms, and extremity numbness were found. Sense disturbance and hyper-reflexes of the lower extremities were found on neurological examination. MRI demonstrated variant demyelinating lesions. Steroid therapy was initiated, and golimumab was discontinued, with good outcomes as the symptoms have disappeared. Discussion: The incidence of demyelination following anti-TNF therapy is uncommon. Most studies have reported that the average time between the anti-TNFα inhibitor treatment and the demyelinating lesion presence is from 5 months to 4 years, and these lesions may appear even after the cessation of the anti-TNFα inhibitor; meanwhile, a total cure of the symptoms after treatment cessation happened in our case, which suggests a causal relation, although a temporal relationship, in this case, cannot be established. The authors believe that golimumab plays a role in the demyelinating lesions development, although it may be a clinical manifestation during the course of Behcet's disease. Conclusion: Caution should be taken for the side effects of Golimumab treatment, such as demyelinating lesions, and long-term monitoring of patients with Bechet disease is required.

Adult-onset Still's disease as the first manifestation of acute myeloid leukemia: a case report.

The association between adult-onset Still's disease (AOSD) and malignancy has previously been observed. However, only a limited number of cases described a combination of AOSD and leukemia, none of which reported AOSD-related symptoms as the first manifestation of acute myeloid leukemia (AML). This presentation might represent a paraneoplastic syndrome or leukemic arthritis mimicking AOSD. Case presentation: Here the authors report a case of a 23-year-old female who fulfilled the Yamaguchi criteria for an AOSD diagnosis. She presented with complaints of polyarthritis, sore throat, and daily fever spikes with the appearance of a nonpruritic maculopapular salmon-colored rash. Her laboratory work showed marked pancytopenia, which led to a bone marrow examination and an AML diagnosis. The patient started receiving chemotherapy with considerable improvement in the AOSD-related symptoms. Clinical discussion: Patients with underlying malignancies could present with systemic features compatible with AOSD, which necessitates excluding malignancy in any patient with this presentation, specifically in light of some warning signs like pancytopenia. Conclusion: This case interprets a rare association between AOSD and AML. In addition, it highlights how crucial it is to be aware of the signs that should warn the clinician of a possible underlying malignancy in any patient presenting with AOSD-related symptoms.