A 76-year-old woman was admitted to our hospital with sudden decrease in visual acuity of her left eye of 24 hours onset.
Among the personal history, we highlight the presence of a long-standing rheumatoid arthritis that had required treatment with methotrexate and was currently being treated with Infliximab (Remicade®) for 20 months.
No antecedents of interest were found.
The fundus examination revealed the following: corrected visual acuity right eye (OD): 1.0 and left eye (left eye): 0.15. Relative afferent pupillary defect in left eye showed bilateral hard cataract
right visual field examination and erythrocyte sedimentation rate (ESR) were normal, and a Humphrey 30-2 campimetry was performed, showing a generalized depression of left visual field sensitivity.
The Farnsworth-Munsell color test of the left eye showed an alteration at the yellow blue axis level.
1.
a skull-orbital magnetic resonance imaging (MRI) showing multiple demyelinating lesions of the subcortical and periventricular white matter.
Considering the irregular morphology of the lesions and their characteristic location, and despite the criteria against age, multiple sclerosis was the first possibility to consider.
However, after consultation with neurology, the possibility arises of a retrobulbar optic neuritis of demyelinating etiology in relation to treatment with Infliximab.
It was decided to suspend the treatment with Infliximab and to start treatment with pulses of 1g of methylprednisolone for 3 days, objectifying a clear recovery of visual acuity of the current moment (1.0) and the subsequent visual field controls
