Figure 54-1 The structure of infliximab.

(Adapted from Knight DM, Trinh H, Le J, Siegel S, Shealy D, McDonough M, Scallon B, et al. Construction and initial characterization of a mouse-human chimeric anti-TNF antibody. Mol Immunol 1993;30[16]:1443–53.)

The finding of conduction block in a patient with a presentation otherwise suggestive of ALS should prompt consideration of an alternative etiology to that of motor neuron disease. One rare ALS mimic to be aware of in patients exposed to infliximab is an autoimmune disease associated with NP-9 antibodies that appears completely reversible with IVIg treatment.

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