Bilateral acute retinal necrosis after ofatumumab masquerading as intermediate uveitis in a patient with multiple...

To report an unique case of bilateral acute retinal necrosis (ARN) associated with ofatumumab use masquerading as intermediate uveitis in a patient with multiple sclerosis.

A 47-year-old female with multiple sclerosis was transitioned to ofatumumab (Arzerra/Kesimpta, Novartis, Cambridge, MA, USA) for better systemic control of her disease. Two months later, she developed floaters with a scotoma in her right eye. Initially, she was diagnosed with intermediate uveitis secondary to a presumed multiple sclerosis flare. However, her symptoms worsened and she was referred to Emory University. Fundus examination revealed bilateral ARN. The patient discontinued the medication and was treated with systemic and intravitreal antivirals with improvement; however, she developed a retinal detachment in her right eye that required surgical repair.

This is a unique case of bilateral ARN after starting ofatumumab medication for multiple sclerosis. This case also highlights the importance of discerning between intermediate uveitis associated with multiple sclerosis and infectious uveitis in the setting of immunocompromise.