Retrobulbar Optic Neuritis Associated with Certolizumab

Aims: to report a case of retrobulbar optic neuritis (ON) associated with certolizumab.

Case Report: A 22-year-old man presented with a 4 days history of decreased vision in the left eye accompanied by pain on extraocular movement. He had received an infusion of certolizumab for juvenile idiopathic arthritis 3 weeks before symptomatology. Ocular examination of the left eye revealed a left afferent pupillary defect. The best-corrected visual acuity was 1/10. Anterior segment and fundoscopy were normal. Clinical presentation suggested ON. We performed visual evoked potentials (VEP) and optical coherence tomography (OCT) to confirm the diagnosis: VEP showed increase in latency of P100 wave in the left eye which was consistent with the diagnosis of ON, OCT was performed in order to follow-up the modifications in the optic nerve head. Magnetic resonance imaging (MRI) was performed to rule out multiple sclerosis or other demyelinating disease. Certolizumab-induced retrobulbar ON is diagnosed by elimination. Certolizumab was discontinued and the patient was treated with corticosteroids with good visual outcome.

Discussion: Occurrence of ON during treatment with anti-tumor necrosis factor α was reported in the literature, mainly with etanercept, then infliximab and adalimumab. There are few cases of ON associated with certolizumab.

Conclusion: This case illustrates the possibility of ON during treatment with certolizumab. Careful monitoring of patients receiving this therapy is necessary to identify ophthalmological or neurological side effects.