Adalimumab-Induced Optic Neuropathy in A Patient with Behçet's Syndrome

Area of Science:

• Ophthalmology
• Rheumatology
• Neuro-immunology

Background:

• Behçet's syndrome is a multisystem inflammatory disorder.
• Ocular manifestations, such as uveitis, are common in Behçet's syndrome.
• Anti-tumour necrosis factor (TNF)-alpha inhibitors are used to manage refractory ocular disease.

Purpose of the Study:

• To report a rare case of iatrogenic optic neuropathy.
• To highlight a potential adverse effect of adalimumab therapy.
• To emphasize the importance of considering drug-induced optic neuritis in patients with Behçet's syndrome.

Main Methods:

• Case report of a 37-year-old woman with Behçet's syndrome.
• Review of treatment history including colchicine, prednisolone, a corticosteroid-sparing agent, and adalimumab.
• Diagnostic workup including blood tests, lumbar puncture, imaging, and sensory evoked potentials.
• Treatment with high-dose systemic corticosteroids.

Main Results:

• The patient developed recurrent ocular inflammation and oral ulceration despite conventional and biologic therapies.
• Adalimumab treatment was followed by a sudden decrease in visual acuity.
• Investigations ruled out infectious and autoimmune causes, but sensory evoked potentials indicated pre-chiasmatic compromise.
• Adalimumab-induced optic neuropathy was diagnosed, leading to treatment suspension and corticosteroid therapy, with subsequent visual improvement.

Conclusions:

• Anti-TNF-alpha inhibitors can paradoxically cause ocular adverse effects, including optic neuritis.
• Iatrogenic optic neuritis due to anti-TNF-alpha inhibitors is a rare but serious complication.
• This diagnosis should be considered in patients with Behçet's syndrome experiencing visual disturbances during anti-TNF-alpha therapy, even with normal inflammatory markers.