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Case Reports
. 2021 Jul 5;33(2):205-208.
doi: 10.4103/2452-2325.312161. eCollection 2021 Apr-Jun.

Sarcoid-Associated Bilateral Multifocal Choroiditis Secondary to Adalimumab

Carl Stanley Wilkins  1 , Kristen Taylor Ashourian  2 , Ethan Kyle Sobol  1 , Matthew Fink  3 , Brian Saltzman  4 , Steven Teich  4
Affiliations
Case Reports

Sarcoid-Associated Bilateral Multifocal Choroiditis Secondary to Adalimumab

Carl Stanley Wilkins et al. J Curr Ophthalmol. .

Abstract

Purpose: To report a rare paradoxical development of systemic sarcoidosis in a patient taking adalimumab manifesting as multifocal choroidal infiltrates and seventh nerve palsy.

Methods: This was a single patient case report.

Results: A 30-year-old man with a history of psoriatic arthritis on adalimumab presented with intermittent fevers and headaches. Initial infectious serology and initial ophthalmic examination were within normal limits. Over the next month, he developed a seventh nerve palsy, unilateral decreased visual acuity, and bilateral multifocal choroidal infiltrates. The patient was diagnosed with systemic sarcoidosis secondary to tumor necrosis factor alpha (TNFα) inhibitor use after a hilar lymph node biopsy. Upon treatment with high-dose oral corticosteroids, the patient's symptoms and choroidal lesions significantly improved.

Conclusion: This case report illustrates a rare presentation of ocular, neurologic, and systemic sarcoidosis presenting as a bilateral multifocal choroiditis and seventh nerve paresis in a patient treated with adalimumab. We highlight the importance of obtaining an ophthalmic evaluation in the management of this rare adverse effect of TNFα inhibitors.

Keywords: Adalimumab; Drug reaction; Multifocal choroiditis; Sarcoidosis; Tumor necrosis factor alpha inhibitor; Uveitis.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a and b) Color fundus photograph of the right (a) and left (b) eyes demonstrating diffuse, well-circumscribed, round, yellow-white choroidal lesions in the posterior pole representing multifocal choroiditis
Figure 2
Figure 2
(a and b) Mid-phase fluorescein angiography of the right (a) and left (b) eyes demonstrating many areas of well-circumscribed hypofluroescence in the posterior pole due to blockage from the choroidal lesions, including more numerous lesions in the macula than seen on ophthalmoscopy. There is notable absence of optic nerve edema, macular edema, or vascular leakage
See this image and copyright information in PMC

References

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