Internuclear ophthalmoplegia associated with anti-TNFα medication

Strabismus
Jonathan Drury, Simon J Hickman

Abstract

To describe the presentation of an internuclear ophthalmoplegia (INO) associated with the use of anti-tumor necrosis factor α (anti-TNFα) medication. A case report of a woman, aged 27 years, who developed facial numbness, blurred vision, and diplopia on right gaze. She had a history of Crohn's disease, which was being treated by the anti-TNFα drug, adalimumab. On examination, a left INO was found. The patient was prescribed a short course of corticosteroids and adalimumab treatment was discontinued. Magnetic resonance imaging demonstrated typical demyelinating lesions including one responsible for the INO. Following a short course of corticosteroids and the discontinuation of the adalimumab treatment, the INO resolved, resulting in a swift improvement of ocular motility over a 2-week period. Anti-TNFα therapies have been associated with the development of demyelinating diseases. The presentation of a brainstem syndrome in a patient on anti-TNFα therapy should lead to investigation for central nervous system demyelination and cessation of the medication.

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Citations

Mar 11, 2020·BMJ Open Ophthalmology·Clara M Castillejo BecerraAlexa Simon Meara
Aug 19, 2017·Current Neurology and Neuroscience Reports·Chandler GillRyan D Jacobson
Apr 28, 2020·Journal of Ophthalmic Inflammation and Infection·Fernanda Nicolela Susanna, Carlos Pavesio
Nov 4, 2021·American Journal of Clinical Dermatology·Mahsaw MotlaghBobeck S Modjtahedi

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