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TitelOptic Neuritis associated with TNF-α antagonist Adalimumab
DoelTo report one recently described potential side effect of the TNF-α antagonist adalimumab (Humira) on the optic nerve.
MethodesA 48-years-old man came to the emergency room and complained of a subacute inferior visual field defect in the left eye. The clinical exam revealed a normal visual acuity 20/20 in both eyes. Fundoscopic examination showed sectorial swelling of the left optic nerve. Automated perimetry identified a bilateral inferior altitudinal scotoma, deeper in the left eye. Laboratory workup and serologic testing to rule out any cause of anterior optic neuropathy in a young adult were all normal. Gadolinium-enhanced MRI of the brain and optic nerves showed no pathological finding neither did the angiographic sequences.
Adalimumab injections were discontinued. A close follow-up of his visual field is now mandatory to confirm the diagnosis.
ResultatenThis case succeeds to 3 previously described clinical cases of adalimumab-associated optic neuritis in the literature. This new TNF-α antagonist recombining monoclonal antibody, approved in 2003 by the FDA, appears to be responsible of optic neuropathy, like the other TNF-α antagonist (infliximab and etanercept). The physiopathological mechanism is still unknown but the hypothesis of inducing or precipitating demyelinating events is hardly suggested.
ConclusieOphthalmologists and rheumatologists should be aware of this potential optical side effect when seeing adalimumab-treated patients. A regular ophthalmologic follow-up in these patients is not yet recommended during treatment but could be questionable.
Auteur 1
NaamDUPONT
InitialenG
StadLiège
Auteur 2
NaamCOLLIGNON
InitialenN
StadLiège
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