Visual Loss Induced by Adalimumab Used for Plaque Psoriasis.

Area of Science:

• Neuro-immunology
• Dermatology
• Ophthalmology

Background:

• Severe plaque psoriasis is a chronic autoimmune condition impacting skin health.
• Adalimumab, a TNF-alpha inhibitor, is a common biologic therapy for psoriasis.
• Biologic therapies can rarely be associated with neurological adverse events.

Observation:

• A 61-year-old male with psoriasis developed acute vision loss in his right eye shortly after starting adalimumab.
• Ophthalmic examination and brain/orbit MRI revealed CNS demyelination and retrobulbar optic neuritis.
• The patient had no prior history of joint involvement or neurological conditions.

Findings:

• Adalimumab therapy was immediately discontinued.
• Neurological symptoms resolved completely within six weeks without further intervention.
• The patient remained stable for 14 months post-cessation, with no recurrence of psoriatic or neurological issues.

Implications:

• This case suggests a potential causal link between adalimumab and CNS demyelination/optic neuritis.
• Ophthalmologic and neurological monitoring may be warranted in patients receiving adalimumab.
• Early recognition and drug cessation can lead to favorable outcomes in managing adalimumab-induced neurotoxicity.