Retrobulbar optic neuritis associated with infliximab in a patient with Crohn's disease

Ouakaa-Kchaou, Asma; Gargouri, Dalila; Trojet, S.; Hefaiedh, Rania; Elloumi, Héla; Kochlef, Asma; Kilani, Afef; Romani, Malika; Kharrat, Jamel; Ghorbel, Abdeljabbar

doi:10.1016/j.crohns.2009.02.007

Cited by 22 publications

(13 citation statements)

References 6 publications

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“…89 One of the toxicities of anti-TNF therapy is the potential to cause a demyelinating disease such as multiple sclerosis. 90 Optic neuropathy has been reported with both infliximab [91][92][93][94] and adalimumab treatments. [94][95][96] Several of these cases occurred in patients with Crohn's disease, who are usually treated with higher doses of anti-TNF therapy than those with rheumatoid arthritis.…”

Section: Management Of Neuro-ophthalmic Sarcoidosismentioning

confidence: 98%

Neuro-ophthalmic sarcoidosis

Baughman¹,

Weiss²,

Golnik³

2012

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Neuro-ophthalmic disease occurs in about a third of patients with neurosarcoidosis. Optic nerve involvement is the most common manifestation, but other cranial nerves and the optic chiasm can be involved. However, there are several other common diseases that cause optic neuropathy, including multiple sclerosis. The diagnosis of sarcoidosis can often be made based on the multi-organ nature of the disease and ancillary testing. Most patients with neuro-ophthalmic sarcoidosis require systemic therapy. While corticosteroids are usually the first step in therapy, cytotoxic agents such as methotrexate and azathioprine have been useful as steroid-sparing agents for chronic disease. The monoclonal antibodies directed against tumor necrosis factor have been reported as effective in refractory cases of neuro-ophthalmic disease.

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Section: Management Of Neuro-ophthalmic Sarcoidosismentioning

confidence: 98%

Neuro-ophthalmic sarcoidosis

Baughman¹,

Weiss²,

Golnik³

2012

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“…Optic neuritis may be a complication of inflammatory bowel disease treatment, with several cases reported in association with treatment with tumor necrosis factor inhibitors (Chan and Castellanos, 2010;Tristano, 2010), and may require discontinuation of treatment and/or change to a different immunosuppressive drug (Felekis et al, 2009a). Most patients improve with corticosteroid treatment (Tran et al, 2005;Han et al, 2006;Felekis et al, 2009b;Ouakaa-Kchaou et al, 2009;Barabino et al, 2011). Figure 20.10 shows a personal case suffering from Crohn disease who had an episode of painless isolated optic neuritis in her left eye.…”

Section: Inflammatory Bowel Diseasementioning

confidence: 99%

Autoimmunity in visual loss

Petzold¹,

Wong

Plant

2016

Handbook of Clinical Neurology

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There are a number of autoimmune disorders which can affect visual function. There are a very large number of mechanisms in the visual pathway which could potentially be the targets of autoimmune attack. In practice it is the retina and the anterior visual pathway (optic nerve and chiasm) that are recognised as being affected in autoimmune disorders. Multiple Sclerosis is one of the commonest causes of visual loss in young adults because of the frequency of attacks of optic neuritis in that condition, however the basis of the inflammation in Multiple Sclerosis and the confirmation of autoimmunity is lacking. The immune process is known to be highly unusual in that it is not systemic and confined to the CNS compartment. Previously an enigmatic partner to Multiple Sclerosis, Neuromyelitis Optica is now established to be autoimmune and two antibodies - to Aquaporin4 and to Myelin Oligodendrocyte Glycoprotein - have been implicated in the pathogenesis. The term Chronic Relapsing Inflammatory Optic Neuropathy is applied to those cases of optic neuritis which require long term immunosuppression and hence are presumed to be autoimmune but where no autoimmune pathogenesis has been confirmed. Optic neuritis occurring post-infection and post vaccination and conditions such as Systemic Lupus Erythematosus and various vasculitides may cause direct autoimmune attack to visual structures or indirect damage through occlusive vasculopathy. Chronic granulomatous disorders such as Sarcoidosis affect vision commonly by a variety of mechanisms, whether and how these are placed in the autoimmune panoply is unknown. As far as the retina is concerned Cancer Associated Retinopathy and Melanoma Associated Retinopathy are well characterised clinically but a candidate autoantibody (recoverin) is only described in the former disorder. Other, usually monophasic, focal retinal inflammatory disorders (Idiopathic Big Blind Spot Syndrome, Acute Zonal Occult Outer Retinopathy and Acute Macular Neuroretinitis) are of obscure pathogenesis but an autoimmune disorder of the post-infectious type is plausible. Visual loss in autoimmunity is an expanding field: the most significant advances in research have resulted from taking a well characterised phenotype and making educated guesses at the possible molecular targets of autoimmune attack.

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“…In contrast to multiple sclerosis, there are no population‐based studies on the occurrence of IIDD in patients with IBD. There are only case reports and case series describing an association between anti‐TNFα exposure and development of IIDDs in patients with IBD . However, there are no previously reported comparisons of the diagnosis of IIDD in patient with IBD with and without treatment with anti‐TNFα agents …”

Section: Discussionmentioning

confidence: 99%

“…It is unclear whether anti‐TNFα biologics cause IIDD. There are published reports of IIDDs in patients exposed to anti‐TNFα agents; however, these have mostly been non‐comparative studies and case reports . Current guidelines recommend discontinuing anti‐TNFα agents in patients with neurological symptoms and white matter lesions.…”

Section: Introductionmentioning

confidence: 99%

Idiopathic inflammatory demyelinating disease of the central nervous system in patients with inflammatory bowel disease: retrospective analysis of 9095 patients

Felice

Novotná

Enders

et al. 2014

Aliment Pharmacol Ther

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Summary Background Anti-TNFα biologics induce and maintain remission in inflammatory bowel disease (IBD). Also, they have been reported to induce or unmask idiopathic inflammatory demyelinating disease of the central nervous system (IIDD). Aim To determine if anti-TNFα biologics increased the risk of IIDD in a large cohort of patients with IBD. Methods We retrospectively identified adult patients referred to the Mayo Clinic, Rochester, MN for management of IBD from a five state capture area (Minnesota, Wisconsin, North Dakota, South Dakota, and Iowa) between 1996 and 2010. IIDDs were identified in both Crohn’s disease (CD) and ulcerative colitis (UC) patients with and without anti-TNFα exposure using the 2010 McDonald MRI criteria. The risk of IIDDs in patients with and without anti-TNFα exposure was estimated for IBD; CD and UC groups separately. Results A total of 9095 patients with IBD were identified (4342 CD and 4753 UC). Four patients with CD with exposure to anti-TNFα agents (4/2054) and five patients with CD without anti-TNFα exposure (5/2288) developed a confirmed IIDD. One patient with UC with exposure to anti-TNFα agents (1/1371) and five patients with UC without anti-TNFα agents developed a confirmed IIDD (5/3382). The percent of IIDDs in patients with and without anti-TNFα exposure was; IBD: 0.15% and 0.18% (RR=0.83, 95%CI: 0.28-2.42; p=0.729); CD: 0.19% and 0.22% (RR=0.89, 95%CI: 0.24-3.31; p=0.863); UC: 0.07% and 0.15% (RR=0.49, 95%CI: 0.06-4.22; p=0.510). Conclusions Anti-TNFα biologics do not appear to impact the risk of developing clinical IIDD in patients with IBD.

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Retrobulbar optic neuritis associated with infliximab in a patient with Crohn's disease

Abstract: : Although the relationship between the onset of visual symptoms and the infusion of infliximab may have been coincidental, we believe that this case report underscores the clinical awareness of the possible association, especially in light of the increasing use of this cytokine inhibitor.

Cited by 22 publications

References 6 publications

Neuro-ophthalmic sarcoidosis

Neuro-ophthalmic sarcoidosis

Autoimmunity in visual loss

Idiopathic inflammatory demyelinating disease of the central nervous system in patients with inflammatory bowel disease: retrospective analysis of 9095 patients

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