Abstract
Aim: To describe the presentation of an internuclear ophthalmoplegia (INO) associated with the use of anti-tumor necrosis factor α (anti-TNFα) medication.
Methods: 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.
Treatment: The patient was prescribed a short course of corticosteroids and adalimumab treatment was discontinued.
Results: 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.
Conclusion: 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.
Acknowledgments
Case written in line with the declaration of Helsinki 1975.
Declaration of interest
The authors report no conflict of interest.