Retrobulbar Optic Neuritis Associated with Certolizumab
Published: 2023-10-16
Page: 88-91
Issue: 2023 - Volume 6 [Issue 1]
Mejda Bouladi *
Ophthalmology Department, Mongi Slim University Hospital, La Marsa, Tunis, Tunisia and Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
Amal Ben Othmen
Ophthalmology Department, Mongi Slim University Hospital, La Marsa, Tunis, Tunisia and Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
Kalou Merieme
Ophthalmology Department, Mongi Slim University Hospital, La Marsa, Tunis, Tunisia and Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
Masmoudi Hedi
Ophthalmology Department, Mongi Slim University Hospital, La Marsa, Tunis, Tunisia and Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
Lamia El Fekih
Ophthalmology Department, Mongi Slim University Hospital, La Marsa, Tunis, Tunisia and Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
*Author to whom correspondence should be addressed.
Abstract
Aims: to report a case of retrobulbar optic neuritis (ON) associated with certolizumab.
Case Report: A 22-year-old man presented with a 4 days history of decreased vision in the left eye accompanied by pain on extraocular movement. He had received an infusion of certolizumab for juvenile idiopathic arthritis 3 weeks before symptomatology. Ocular examination of the left eye revealed a left afferent pupillary defect. The best-corrected visual acuity was 1/10. Anterior segment and fundoscopy were normal. Clinical presentation suggested ON. We performed visual evoked potentials (VEP) and optical coherence tomography (OCT) to confirm the diagnosis: VEP showed increase in latency of P100 wave in the left eye which was consistent with the diagnosis of ON, OCT was performed in order to follow-up the modifications in the optic nerve head. Magnetic resonance imaging (MRI) was performed to rule out multiple sclerosis or other demyelinating disease. Certolizumab-induced retrobulbar ON is diagnosed by elimination. Certolizumab was discontinued and the patient was treated with corticosteroids with good visual outcome.
Discussion: Occurrence of ON during treatment with anti-tumor necrosis factor α was reported in the literature, mainly with etanercept, then infliximab and adalimumab. There are few cases of ON associated with certolizumab.
Conclusion: This case illustrates the possibility of ON during treatment with certolizumab. Careful monitoring of patients receiving this therapy is necessary to identify ophthalmological or neurological side effects.
Keywords: Biologic therapy, tumor necrosis factor-alpha, optic neuritis, adverse events