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Letters |20 April 2004

Retrobulbar Optic Neuritis Associated with Infliximab in a Patient with Crohn Disease

Betsy Y.C. Strong, MD; Barbara C. Erny, MD; Howard Herzenberg, MD; Kristen J. Razzeca, MD

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  • From Camino Medical Group, Sunnyvale, CA 94086.
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TO THE EDITOR:
Case Report: A 45-year-old woman with type 2 diabetes mellitus and Crohn disease developed retrobulbar optic neuritis that was temporally associated with infliximab treatment. Three years earlier, she had Bell palsy, which resolved. Two years earlier, she received a diagnosis of Crohn disease and nongranulomatous uveitis. She responded initially to prednisone and mesalamine, but her condition later worsened, and she developed an enterovaginal fistula. She responded well to azathioprine; intravenous antibiotics; intravenous corticosteroids; and infliximab, 5 mg/kg of body weight. She continued to take infliximab every other month, and corticosteroids were successfully withdrawn.
A week after the seventh infusion of infliximab, the patient developed pain and blurred vision in the left eye. She had no symptoms of colitis. Visual acuity was 20/70. The patient had a constricted visual field, afferent pupillary defect, and normal left eye on slip-lamp examination. There was pain on palpation of the orbit, and extraocular movements were full but induced pain with upward gaze. Ophthalmoscopic examination revealed trace edema of the optic nerve. The patient was hospitalized for increasing pain and vision loss in the left eye. Complete blood count, sedimentation rate, and results of contrast-enhanced brain magnetic resonance imaging (MRI) were normal.
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Strong BY, Erny BC, Herzenberg H, Razzeca KJ. Retrobulbar Optic Neuritis Associated with Infliximab in a Patient with Crohn Disease. Ann Intern Med. ;140:W–34. doi: 10.7326/0003-4819-140-8-200404200-00037-w4

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Published: Ann Intern Med. 2004;140(8):W-34.

DOI: 10.7326/0003-4819-140-8-200404200-00037-w4

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