A Case of Optic Neuritis Under Adalimumab Therapy

Abstract

We report the case of a patient who presented with optic neuritis while being treated with adalimumab (ADA) for ulcerative colitis (UC). A 42-year-old woman had been diagnosed with UC 13 years before, and had been receiving ADA therapy since February 2015. She presented with right eye pain in April 2015, and was referred to us when her symptoms did not improve. The best corrected visual acuity was 0.6 and the critical flicker frequency (CFF) was 12.3 Hz in the right eye. Additionally, she also had a paracentral scotoma in the right eye. Magnetic resonance imaging (MRI) showed increased signal intensity in the right optic nerve and fundus angiography showed hyperfluorescence in the right optic nerve head. We investigated the possibility of multiple sclerosis or neuromyelitis optica; however, testing of the cerebrospinal fluid and autoantibody tests yielded normal results. The patient was diagnosed with right optic neuritis due to ADA therapy. Following the discontinuation of ADA and steroid pulse therapies, visual acuity in the right eye improved to 1.5, CFF improved to 33.3 Hz, and the paracentral scotoma disappeared. Since optic neuritis can be caused by anti-TNF-α therapy, to ensure an accurate diagnosis, it is necessary to obtain a detailed medical history of the patient.