Internuclear Ophthalmoplegia Associated with Anti-TNFα Medication

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.

• Adalimumab
• diplopia
• internuclear ophtalmoplegia
• neuro-ophthalmology
• orthoptists
• strabismus

Acknowledgments

Case written in line with the declaration of Helsinki 1975.

Declaration of interest

The authors report no conflict of interest.