scholarly journals Bilateral Optic Neuritis Associated with the Use of Infliximab

2011 ◽  
Vol 2011 ◽  
pp. 1-2 ◽  
Author(s):  
Jan O. Aasly
Keyword(s):  
Optic Neuritis ◽  
Inflammatory Diseases ◽  
Visual Fields ◽  
Tnf Alpha ◽  
First Year ◽  
Blurred Vision ◽  
Tnf Antagonists ◽  
History Of ◽  
The Right ◽  
Necrosis Factor

A 40 year old man was admitted with a 2 weeks history of headache, blurred vision and bilateral optic neuritis. During the 6 months period prior to admission he had treated with infliximab infusions for prsoriasis arthritis. He had 0.2 vision in right eye and 0.5 in left Fundoscopy showed moderate disc swelling more on the right than on the left side and right-sided splinter heamorrhages at the disc margin. The intracranial pressure was normal. He was treated with oral methylprednisolone, 100 mg daily for 1 week. His vision improved gradually and when seen 10 weeks later his visual acuity was 1.0 in both eyes and he had normal visual fields. Optic neuritis is a rare but well recognized serious adverse effect of treatments with tumor necrosis factor (TNF) antagonists. This case report illustrates a rare but typical side effect of a TNF alpha inhibitors used for treating a number of inflammatory diseases. These reactions usually appear during first year of treatments and never after the first one or two infusions. Both genders and all ages are affected. In some patients the visual defects are irreversible.

scholarly journals Demyelinizing Neurological Disease after Treatment with Tumor Necrosis Factor-α Antagonists

2016 ◽  
Vol 7 (2) ◽  
pp. 345-353 ◽  
Author(s):  
Claudia Bruè ◽  
Cesare Mariotti ◽  
Ilaria Rossiello ◽  
Andrea Saitta ◽  
Alfonso Giovannini
Keyword(s):  
Visual Field ◽  
Tumor Necrosis Factor ◽  
Optic Neuritis ◽  
Neurological Disease ◽  
Tumor Necrosis ◽  
Rare Complication ◽  
Visual Field Examination ◽  
Study Results ◽  
The Right ◽  
Necrosis Factor

Purpose: Demyelinizing neurological disease is a rare complication after treatment with tumor necrosis factor (TNF)α antagonists. We report on a case of multiple sclerosis after TNFα antagonist treatment and discuss its differential diagnosis. Methods: This is an observational case study. Results: A 48-year-old male was referred to Ophthalmology in January 2015 for an absolute scotoma in the superior quadrant of the visual field in his right eye. Visual acuity was 20/50 in the right eye and 20/20 in the left. Fundus examination was unremarkable bilaterally. Spectral domain optical coherence tomography revealed a normal macular retina structure. Visual field examination revealed a superior hemianopsia in the right eye. Head magnetic resonance imaging showed findings compatible with optic neuritis. The visual evoked potentials confirmed the presence of optic neuritis. The patient had been under therapy with adalimumab since January 2014, for Crohn’s disease. Suspension of adalimumab was recommended, and it was substituted with tapered deltacortene, from 1 mg/kg/day. After 1 month, the scotoma was resolved completely. Conclusions: TNFα antagonists can provide benefit to patients with inflammatory autoimmune diseases. However, they can also be associated with severe adverse effects. Therefore, adequate attention should be paid to neurological abnormalities in patients treated with TNFα antagonists.

scholarly journals Antiphospholipid Antibody Syndrome Presenting with Hemichorea

2012 ◽  
Vol 2012 ◽  
pp. 1-2 ◽  
Author(s):  
Yezenash Ayalew ◽  
Fazlihakim Khattak
Keyword(s):  
First Trimester ◽  
Anticardiolipin Antibodies ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Blurred Vision ◽  
Significant Family History ◽  
History Of ◽  
The Right ◽  
Time Of Presentation ◽  
Underlying Pathophysiology

A 25-year-old Bangladeshi lady presented to neurology with a three-month history of involuntary movements of her right arm, associated with loss of power. There was progression to the right leg, and she subsequently developed episodes of slurred speech and blurred vision. At the time of presentation, she was 12 weeks pregnant and the symptoms were reported to have started at conception. Past medical history was unremarkable apart from one first trimester miscarriage and there was no significant family history suggestive of a hereditary neurological condition. MRI of the head revealed no abnormalities but serology showed positive antinuclear antibodies (ANAs) at a titre of 1/400. Further investigations revealed strongly positive anticardiolipin antibodies (>120) and positive lupus anticoagulant antibodies. The patient had a second miscarriage at 19 weeks gestation strengthening the possibility that the chorea was related to antiphospholipid antibody syndrome and she was started on a reducing dose of Prednisolone 40 mg daily and aspirin 300 mg daily. Six months later, she had complete resolution of neurological symptoms. There are several reports of chorea as a feature of antiphospholipid syndrome, but no clear consensus on underlying pathophysiology.

scholarly journals P32 Relapsing polychondritis with anterior scleritis in young female

2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Umair Arain ◽  
Abimbola Phillips ◽  
Ben Burton ◽  
Damodar Makkuni
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Visual Fields ◽  
Delayed Diagnosis ◽  
Relapsing Polychondritis ◽  
Young Female ◽  
Blurred Vision ◽  
Ocular Findings ◽  
Anterior Scleritis ◽  
The Right

Abstract Case report - Introduction Relapsing polychondritis (RP) was first recognized as a clinical entity in 1923 by Jaksch-Wartenhorst (1923) and reported by him under the title "polychondropathia". The term "relapsing polychondritis" was first used by Pearson, Kline, and Newcomer (1960). Because the ocular findings can be the initial findings of RP, ophthalmologists should know the major ocular findings of this disease. Isaak et al reported that the most common ocular finding is episcleritis (39%) and the second is scleritis (14%). Other signs are iritis (9%), retinopathy (9%), muscle paresis (5%), and optic neuritis (5%). Case report - Case description A 45-year-old female with known rheumatoid arthritis referred by rheumatology in eye clinic due to blurred vision and dry eye. The patient was on hydroxychloroquine and sulfasalazine. No retinal toxicity was found on examination, OCT and Visual Fields. The vision was 6/6 both eyes. Follow-up was in 12 months. She presented 6 months later in casualty with severe pain in her right eye. Examination showed diffuse anterior scleritis with secondary conjunctival inflammation. Anterior chamber cells present. Posterior segment showed no inflammation. Left eye was unremarkable. She was started on Froben 100mg tds with omeprazole. She was seen after a week and condition was improving. She was asked to taper off the meds. Inflammation resolved with 6/5 vision in both eyes and the next appointment was made in a year to monitor for hydroxychloroquine toxicity. In November 2020 she was seen by ENT with inflammation of the right ear cartilage. The pictures showed that the pinna was spared and cartilage was only involved. There was nasal crusting and stuffy nose but without any respiratory symptoms. She was prescribed 50mgs of prednisolone and this helped with her inflammation. She was seen by rheumatology later on and hydroxychloroquine and sulfasalazine was stopped, and she was started on methotrexate 10mgs weekly and folic acid 5mg weekly. Pulmonary function test and echocardiogram was ordered. The case was discussed in MDT rheumatology and it was decided that if joint symptoms got worse than biologics could be started. Methotrexate increased to 15mg subcut. Echocardiogram was normal with satisfactory blood tests. Her next appointment is in October 2021. Case report - Discussion Initially the patient was diagnosed with rheumatoid arthritis with ocular inflammation (anterior scleritis) and was given the standard treatment of steroids to which the patient responded as well. Later when she developed the ear inflammation which involved only the cartilage the diagnosis was revised by rheumatology and changed to RP. As this is a rare life-threatening disease management was switched to immunosuppressive therapy to which she is currently responding well. Case report - Key learning points It is important to consider the possibility that a rheumatology patient may have more than one diagnosis or be open to the idea of revising the diagnosis as the clinical picture evolves over the time. Given the nature of the disease all the systemic features should be examined thoroughly as any one missed area can lead to delayed diagnosis.

scholarly journals Effects of Anti-TNF Alpha Drugs on Disability in Patients with Rheumatoid Arthritis: Long-Term Real-Life Data from the Lorhen Registry

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Matteo Filippini ◽  
Chiara Bazzani ◽  
Fabiola Atzeni ◽  
Piercarlo Sarzi Puttini ◽  
Antonio Marchesoni ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Marked Improvement ◽  
Real Life ◽  
Tnf Alpha ◽  
First Year ◽  
Life Data ◽  
Highly Active ◽  
Real Life Data ◽  
History Of

This study involving 1033 patients with RA confirms the effectiveness of etanercept, adalimumab, and infliximab in reducing RA-related disability even in patients with a history of highly active and longstanding RA. Moreover, we found that the improvement in disability was biphasic, with a marked improvement during the first year of anti-TNF therapy, followed by slower but significant recovery over the subsequent four years.

scholarly journals Visual Loss from Choroidal Melanoma Mimicking Neurological Syndromes

2017 ◽  
Vol 9 (1) ◽  
pp. 31-35
Author(s):  
Karim Hammamji ◽  
Ehud Reich ◽  
Amit Arora ◽  
Victoria M.L. Cohen ◽  
Mandeep S. Sagoo
Keyword(s):  
Optic Neuritis ◽  
Visual Loss ◽  
Vision Loss ◽  
White Male ◽  
Choroidal Melanoma ◽  
Proton Beam Radiotherapy ◽  
Pet Ct ◽  
Oral Steroids ◽  
History Of ◽  
The Right

Melanoma of the eye is rare, but can mimic a range of disorders. This report highlights 2 cases of choroidal melanoma with vision loss mimicking neurological diagnoses. The first patient is a 41-year-old white male with a known history of multiple sclerosis and a previous episode of optic neuritis in the right eye, who presented with a 6-month history of decreased vision in the same eye, and occasional photopsiae. He was treated with 2 courses of oral steroids for presumed recurrent optic neuritis. After a temporary improvement in his symptoms, his vision worsened, following which he had a head MRI, which revealed a solid intraocular mass. He was subsequently diagnosed with a choroidal melanoma for which he was treated successfully with ruthenium-106 plaque brachytherapy. The second patient is a 57-year-old female, who presented with a progressive cerebellar syndrome under investigation by the neurology service, as well as decreased vision in the right eye. Her visual acuity gradually deteriorated and her neurological assessment, which included a PET-CT, revealed uptake in the right eye. The diagnosis of a choroidal melanoma was made, and following conservative treatment with proton beam radiotherapy, she had an enucleation of the eye. Intraocular tumours can masquerade as many different entities. Unexplained unilateral visual loss, especially if it is atypical for a neurological syndrome, should prompt dilated fundoscopy and referral to an ophthalmologist.

scholarly journals Adie’s tonic pupil presenting with unilateral photophobia successfully treated with dilute pilocarpine

2020 ◽  
Vol 13 (1) ◽  
pp. e233136
Author(s):  
Hatim Batawi ◽  
Jonathan A Micieli
Keyword(s):  
Symptomatic Relief ◽  
Pharmacological Therapy ◽  
Blurred Vision ◽  
Third Nerve Palsy ◽  
Tonic Pupil ◽  
History Of ◽  
Blurry Vision ◽  
The Right ◽  
Pharmacological Testing ◽  
Left Pupil

A 40-year-old healthy man presented with a 4-month history of photophobia, blurred vision and a right dilated pupil. Examination revealed a right pupil that was not reactive to light but constricted strongly to a near target and slowly redilated when he looked back in the distance. Pharmacological testing with dilute pilocarpine 0.1% resulted in constriction of the right pupil but no change in the left pupil. This also resulted in resolution of his photophobia and blurry vision. Neurological examination was otherwise normal, and a diagnosis of Adie’s tonic pupil was made. The main differential diagnosis to consider for a large pupil is a third nerve palsy, pharmacological mydriasis, tonic pupil and local iris processes, such as iris sphincter tears from trauma. Knowledge of the key features of these conditions can avoid wasted resources from unnecessary testing. Dilute pilocarpine 0.1% three times a day can be considered as a pharmacological therapy for symptomatic relief.

Interface fluid syndrome secondary to endothelial failure due to toxic anterior segment syndrome after cataract surgery

2018 ◽  
Vol 29 (3) ◽  
pp. NP1-NP4
Author(s):  
Burcu Kasım ◽  
Yusuf Koçluk ◽  
Ayşe Burcu
Keyword(s):  
Cataract Surgery ◽  
Cell Function ◽  
Anterior Segment ◽  
Laser In Situ Keratomileusis ◽  
Blurred Vision ◽  
Endothelial Cell Function ◽  
History Of ◽  
Toxic Anterior Segment Syndrome ◽  
The Right

Purpose: To present a case of previous laser in situ keratomileusis with interface fluid syndrome secondary to toxic anterior segment syndrome following cataract surgery. Case report: A 52-year-old woman, complaining blurred vision in her right eye for 18 months after cataract surgery, was referred to our clinic. She was diagnosed with toxic anterior segment syndrome, postoperatively, which resolved in 3 days. She had a history of laser in situ keratomileusis surgery 15 years ago. Slit-lamp examination of the right eye showed corneal haze, limited to laser in situ keratomileusis flap. The patient was diagnosed with interface fluid syndrome secondary to endothelial decompensation due to toxic anterior segment syndrome. Descemet’s membrane endothelial keratoplasy was performed along with full thickness fenestrations in the laser in situ keratomileusis flap to the right eye of the patient. The fluid was resolved in 1 week and visual acuity was improved rapidly. Conclusion: This case shows the importance of considering the diagnosis and determining the specific etiology of interface fluid syndrome, even years after the laser in situ keratomileusis surgery, when endothelial cell function has been compromised with any factor, such as intraocular surgery and its complications.

scholarly journals Relationship Between Pack-year History of Smoking and Response to Tumor Necrosis Factor Antagonists in Patients with Rheumatoid Arthritis

2009 ◽  
Vol 36 (6) ◽  
pp. 1180-1187 ◽  
Author(s):  
DEREK L. MATTEY ◽  
ANN BROWNFIELD ◽  
PETER T. DAWES
Keyword(s):  
Tumor Necrosis Factor ◽  
Disease Activity ◽  
Tumor Necrosis ◽  
Disease Activity Score ◽  
Response To Therapy ◽  
Activity Score ◽  
Smoking History ◽  
Tnf Antagonists ◽  
History Of ◽  
Necrosis Factor

Objective.To determine whether there is a quantitative relationship between smoking history and response to therapy with tumor necrosis factor (TNF) antagonists.Methods.A history of cigarette smoking was obtained from a questionnaire completed by each patient starting therapy with TNF antagonists since 2002 (n = 154). A core set of demographic and clinical variables was recorded at baseline and at 3 and 12 months. The extent of smoking was quantified in pack-years (py), with 1 py equivalent to 20 cigarettes per day for 1 year. The association between smoking intensity and response was assessed using contingency tables and logistic regression analysis. Response to therapy was defined according to the European League Against Rheumatism improvement criteria.Results.There was an increasing trend of no response at 3 and 12 months with increasing py history [p (trend) = 0.008 and 0.003, respectively]. The change in Disease Activity Score (DAS)28 over the first 3 months was inversely associated with the number of py (r = −0.28, p = 0.002). The association of py history with response failure was independent of age, sex, disease duration, baseline disease activity score (DAS28), Health Assessment Questionnaire (HAQ) score, IgM rheumatoid factor, and smoking at baseline. The most significant effect was seen in patients treated with infliximab.Conclusion.RA patients with a history of smoking were more likely to show a poor response to TNF antagonists. Response failure was associated with the intensity of previous smoking, irrespective of smoking status at initiation of anti-TNF therapy.

scholarly journals Multiple phakomatoses and primary open-angle glaucoma in one individual

2020 ◽  
Vol 17 (3) ◽  
pp. 290-301
Author(s):  
Arjit Mitra ◽  
Debarpita Chaudhury ◽  
Sumit Choudhury ◽  
Suchanda Sar ◽  
Smita Ghosh
Keyword(s):  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Visual Fields ◽  
Neurofibromatosis Type ◽  
Open Angle ◽  
Nevus Of Ota ◽  
Lisch Nodules ◽  
History Of ◽  
Systemic Examination ◽  
The Right

A 50-year-old woman presented with conjunctival melanosis, scleral pigmentation, and Lisch nodules in her left eye. Intraocular pressure was 24 mmHg in the right eye and 14 mmHg in the left eye. She had open angles on gonioscopy. Fundus examination showed a cup-to-disc ratio of 0.7 in the right eye, with an inferior notch and a splinter hemorrhage, and 0.6 in the left eye, with a deep cup with sloping rims. Humphrey visual fields showed an evolving superior arcuate scotoma in her right eye; the left eye was normal. Systemic examination showed axillary freckling. The patient had a family history of neurofibromatosis type 1 (NF-1), her father having been diagnosed with the condition. She had hyperpigmentation of the skin over the forehead and periocular skin on the left side. These unique ocular and systemic features were suggestive of two phakomatoses, NF-1 and nevus of Ota, in one eye, and primary open-angle glaucoma (POAG) in the other eye. that is, three pathologies present together in the same individual, which is an extremely rare occurrence.

Trauma-induced filtering bleb formation and blebitis 40 years following a penetrating eye injury

2020 ◽  
Vol 13 (6) ◽  
pp. e234355
Author(s):  
Yee Ling Wong ◽  
Vikas Shankar
Keyword(s):  
Ocular Trauma ◽  
Medical Attention ◽  
Blurred Vision ◽  
Filtering Bleb ◽  
Penetrating Eye Injury ◽  
Close Proximity ◽  
History Of ◽  
Bleb Formation ◽  
The Right

A 49-year-old man presented to the emergency eye clinic with a 3-week history of redness, irritation and blurred vision in his right eye, with a noticeable lesion superotemporally on the conjunctiva. He had a previous ocular history of penetrating glass injury in the right eye at the age of 9 years (40 years ago), of which no surgical intervention was performed at that time, as his parents did not seek medical attention. Slit lamp examination revealed a thin, conjunctival cystic bleb at 10 o’clock position with surrounding conjunctival injection and chemosis at close proximity to the site of previous ocular trauma. Investigations confirmed a diagnosis of trauma-induced filtering bleb with blebitis (bleb inflammation). The patient was treated with a combination of steroid and antibiotic drops for duration of 2 weeks. Subsequent follow-up revealed marked improvement of symptoms with reduced inflammation. Patient is being monitored regularly to prevent recurrence of blebitis and bleb associated complications.

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