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Year : 2021  |  Volume : 33  |  Issue : 2  |  Page : 205-208

Sarcoid-associated bilateral multifocal choroiditis secondary to adalimumab

1 Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
2 Department of Ophthalmology, Stroger Eye Clinic/Cook County Health, Chicago, IL, USA
3 Department of Neurology, Weill Cornell Medicine, Cornell University, New York, NY, USA
4 Icahn School of Medicine at Mount Sinai, New York, NY, USA

Correspondence Address:
Carl Stanley Wilkins
New York Eye and Ear Infirmary Retina Center, 310 East 14th Street, New York, NY
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2452-2325.312161

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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.

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