Tumor necrosis factor-α antagonists have become a therapeutic mainstay for various inflammatory diseases including Hidradenitis Suppurativa. Despite their clinical efficacy, these medications have been associated with the rare development of demyelinating diseases. We report a 29-year-old male who developed neurological symptoms while taking adalimumab, a tumor necrosis factor-α antagonist, for treatment of Hidradenitis Suppurativa. The patient was subsequently diagnosed with radiologically isolated syndrome based on magnetic resonance imaging findings. The exact temporal relationship between demyelinating disease and tumor necrosis factor-α antagonists is poorly understood. Also, there remain a few effective treatment options for severe inflammatory diseases like Hidradenitis Suppurativa. In cases where a patient exhibits clinical stability and structural resolution following the development of neurological symptoms after tumor necrosis factor-α antagonist therapy, and there is a lack of other effective treatments to control extensive inflammatory disease, restarting the tumor necrosis factor-α antagonist could be considered provided there is neurology approval and close monitoring.

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