Adalimumab-Associated Transverse Myelitis Revealing Relapsing-Remitting Multiple Sclerosis in a Patient With Crohn’s Disease: A Case Report

We report the case of a 40-year-old woman with a background of Crohn's disease treated with azathioprine and adalimumab, who presented with acute right leg weakness, sensory loss, and urinary hesitancy. The MRI revealed a longitudinal cervical spinal cord lesion consistent with transverse myelitis (TM) and a supratentorial white matter lesion. The CSF analysis demonstrated unmatched oligoclonal bands, supporting central nervous system (CNS) demyelination. A prior episode of facial numbness in 2022 was retrospectively recognized as a previous relapse. These findings fulfilled the McDonald criteria for relapsing-remitting multiple sclerosis (RRMS). This case highlights the diagnostic challenges in patients with autoimmune disease receiving anti-tumor necrosis factor (TNF) therapy and underscores the importance of considering multiple sclerosis (MS) in such clinical contexts. The patient was treated with corticosteroids, while adalimumab was discontinued, and she demonstrated gradual neurological improvement over several weeks.