AIM: To describe the presentation of an internuclear ophthalmoplegia (INO) associated with the use of anti-tumor necrosis factor á (anti-TNFá) medication.METHODS: A case report of a woman, aged 27 years, who developed facial numbness, blurred vision, and diplopia on right gaze. She had a history of Crohn's disease, which was being treated by the anti-TNFá drug, adalimumab. On examination, a left INO was found.TREATMENT: The patient was prescribed a short course of corticosteroids and adalimumab treatment was discontinued.RESULTS: Magnetic resonance imaging demonstrated typical demyelinating lesions including one responsible for the INO. Following a short course of corticosteroids and the discontinuation of the adalimumab treatment, the INO resolved, resulting in a swift improvement of ocular motility over a 2-week period.CONCLUSION: Anti-TNFá therapies have been associated with the development of demyelinating diseases. The presentation of a brainstem syndrome in a patient on anti-TNFá therapy should lead to investigation for central nervous system demyelination and cessation of the medication.
Adalimumab Adult