title: Demyelinizing Neurological Disease after Treatment with Tumor Necrosis Factor-α Antagonists.
abstract: OBJECTIVE
  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.
authors: Ophthalmology, Department of Neuroscience, Polytechnic University of Marche, Ancona, Italy.
authors: Claudia
authors: C
authors: Bruè
authors: Ophthalmology, Department of Neuroscience, Polytechnic University of Marche, Ancona, Italy.
authors: Cesare
authors: C
authors: Mariotti
authors: Ophthalmology, Department of Neuroscience, Polytechnic University of Marche, Ancona, Italy.
authors: Ilaria
authors: I
authors: Rossiello
authors: Ophthalmology, Department of Neuroscience, Polytechnic University of Marche, Ancona, Italy.
authors: Andrea
authors: A
authors: Saitta
authors: Ophthalmology, Department of Neuroscience, Polytechnic University of Marche, Ancona, Italy.
authors: Alfonso
authors: A
authors: Giovannini
keywords: Adalimumab; Optic neuritis; Tumor necrosis factor antagonists