title: Adalimumab for orbital myositis in a patient with Crohn's disease who discontinued infliximab: a case report and review of the literature.
abstract: BACKGROUND
  Orbital myositis is a rare extra-intestinal manifestation of inflammatory bowel disease. Seventeen cases of Crohn's disease associated orbital myositis and 3 cases of ulcerative colitis associated orbital myositis have been reported in the published literature since 1970. We report the use of adalimumab (Abbott, Canada, Inc.) for orbital myositis in a patient with Crohn's disease who discontinued infliximab (Janssen, Canada, Inc.) and review of the published literature.
  
  
  METHODS
  A 35 year-old male with a 7-year history of Crohn's disease was treated with an ileocolonic resection and re-anastomosis followed by infliximab which maintained full endoscopic and clinical remission for four years. After stopping the infliximab for infusion-related reactions he presented with 3-day history of severe right eye pain, pain with ocular movement, proptosis, and conjunctival injection. He had no intestinal symptoms and endoscopic assessment revealed no active luminal disease. CT of the orbit revealed an enlarged right medial rectus muscle with tendonous involvement and a diagnosis of orbital myositis was made. Treatment with 80 mg per day prednisone with tapering dose and adalimumab, induction and maintenance, resulted in rapid resolution of the orbital myositis and ocular symptoms with no recurrences on follow-up at 10 months.
  
  
  CONCLUSIONS
  The current case demonstrates a rare extraintestinal manifestation of Crohn's disease, orbital myositis, and its temporal relationship to the discontinuance of infliximab therapy and its successful treatment, without recurrence with tapering prednisone and adalimumab.
authors.affiliation: Division of Gastroenterology, University of Alberta, Zeidler Ledcor Center, Edmonton, Alberta, Canada T6G 2X8.
authors.forename: Sanam
authors.initials: S
authors.lastname: Verma
authors.forename: Karen I
authors.initials: KI
authors.lastname: Kroeker
authors.forename: Richard N
authors.initials: RN
authors.lastname: Fedorak
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D000069285:Infliximab; D008297:Male; D055622:Orbital Myositis / Q000150:complications / Q000188:drug therapy*; D011241:Prednisone / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069285:Infliximab; D000068879:Adalimumab; D011241:Prednisone
references.citation: J Crohns Colitis. 2008 Dec;2(4):337-42
references.pmid: 21172235
references.citation: Orbit. 2001 Mar;20(1):75-80
references.pmid: 12045937
references.citation: Br J Ophthalmol. 2001 Oct;85(10):1220-4
references.pmid: 11567968
references.citation: Ann Ophthalmol. 1984 Mar;16(3):275-8
references.pmid: 6712071
references.citation: Am J Gastroenterol. 2005 Sep;100(9):2136-7
references.pmid: 16128967
references.citation: J Rheumatol. 2005 Jul;32(7):1374-5
references.pmid: 15996084
references.citation: Childs Nerv Syst. 2012 Apr;28(4):641-3
references.pmid: 22009155
references.citation: Am J Gastroenterol. 1992 Mar;87(3):405-6
references.pmid: 1539588
references.citation: Can J Gastroenterol. 1997 Sep;11(6):497-500
references.pmid: 9347163
references.citation: J Pediatr Gastroenterol Nutr. 1992 Nov;15(4):448-51
references.pmid: 1469529
references.citation: J Fr Ophtalmol. 2005 Jun;28(6):610-3
references.pmid: 16141924
references.citation: J Pediatr. 1982 Jul;101(1):157-8
references.pmid: 7086617
references.citation: Medicine (Baltimore). 1976 Sep;55(5):401-12
references.pmid: 957999
references.citation: Inflamm Bowel Dis. 2012 Jan;18(1):1-9
references.pmid: 21351211
references.citation: Inflamm Bowel Dis. 2004 Mar;10(2):135-9
references.pmid: 15168814
references.citation: Am J Ophthalmol. 2004 Dec;138(6):925-30
references.pmid: 15629282
references.citation: J Crohns Colitis. 2012 Oct;6(9):958-9
references.pmid: 22704659
references.citation: Curr Rheumatol Rep. 2010 Dec;12(6):443-7
references.pmid: 20803107
references.citation: Am J Gastroenterol. 2001 Dec;96(12):3442-4
references.pmid: 11774970
references.citation: J Crohns Colitis. 2011 Jun;5(3):265-6
references.pmid: 21575896
references.citation: J Crohns Colitis. 2010 Sep;4(3):349-50
references.pmid: 21122528
references.citation: Gut. 2006 Mar;55 Suppl 1:i36-58
references.pmid: 16481630
references.citation: Bull Soc Belge Ophtalmol. 1984;210:65-72
references.pmid: 6152753
references.citation: Ophthalmic Plast Reconstr Surg. 2012 Sep-Oct;28(5):e119-20
references.pmid: 22366668
references.citation: Surv Ophthalmol. 1999 Nov-Dec;44(3):187-213
references.pmid: 10588439
references.citation: Clin Imaging. 2008 May-Jun;32(3):227-9
references.pmid: 18502352
references.citation: Gastroenterology. 1999 Oct;117(4):761-9
references.pmid: 10500056