Abstract Details

Title Atypical Optic Neuritis Associated with golimumab

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P13 - Poster Session 13 (8:00 AM-9:00 AM)

Poster/Presentation
Number 2-004

Background

TNFAIs are novel therapeutic options in a variety of immune-mediated diseases. On the other hand, these immunotherapies can induce or exacerbate central nervous system demyelination. Although this adverse effect has been described with conventional TNFAIs, there is still little evidence in the newer agents in this class, including golimumab.

Objective To describe a case of atypical optic neuritis induced by golimumab, a tumor necrosis factor-alpha inhibitor (TNFAI).

Design/Methods Case report

Results A 48-year-old woman developed acute visual loss in the right eye after receiving golimumab, the newer TNF-alpha inhibitor for her psoriasis arthritis. Six months prior, she had an episode of self-limited left arm numbness. The patient’s right eye visual acuity was hand motion with 2+ relative afferent pupillary defect at presentation. Left eye visual acuity was 20/20. The anterior chamber and vitreous cavity were normal. Funduscopic examination showed normal optic discs bilaterally. A neurological exam revealed decreased proprioception in the left arm and generalized hyperreflexia. MRI neuroaxis showed T2 hyperintensity lesions in the periventricular area and left posterior column of the cervical spinal cord. Serum AQP4 IgG and MOG IgG were negative. Serum Borrelia burgdorferi antibody was also negative. Therefore, the diagnosis of multiple sclerosis (MS) and optic neuritis (ON) was made. A 5-day course of intravenous methylprednisolone 1 g daily was given, and golimumab was discontinued. Dimethyl fumarate was started for the MS treatment. She had no clinical or radiographical MS activity, but there was no visual improvement at 1 year.

Conclusions

Our case not only provides evidence of severe atypical optic neuritis associated with golimumab in a patient with a prior episode of undiagnosed CNS demyelination. Furthermore, our case highlights the importance of careful history taking and consideration of neuroimaging to rule out central nervous system demyelinating diseases before start TNFAI therapy.

Authors/Disclosures
Smathorn Thakolwiboon, MD (Mayo Clinic Health System) PRESENTER	Dr. Thakolwiboon has nothing to disclose.
	No disclosure on file
Mirla L. Avila, MD (Texas Tech University Health Sciences Center)	Dr. Avila has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Genzyme, BMS, Serono. Dr. Avila has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for biogen, genzyme, BMS. The institution of Dr. Avila has received research support from Texas Tech.