Adalimumab induced multiple sclerosis-like findings in pediatric patient with uveitis
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Yes
Purpose
To report a rare case of induced multiple sclerosis-like findings in pediatric patient with uveitis after treatment with adalimumab and to highlight the importance of early recognition of this adverse effect.
Methods
A case report
Results
A 15-year-old HLA B51 and HLA DR15 positive patient with no systemic manifestations was treated with methotrexate and adalimumab for noninfectious chronic bilateral intermediate uveitis with poor control of disease activity and multiple ocular complications. Three years after starting adalimumab, the patient developed unilateral optic neuritis. Magnetic resonance imaging (MRI) of the brain and spinal cord revealed demyelinating lesions consistent with multiple sclerosis. Neurological workup suspected the diagnosis of adalimumab induced multiple sclerosis. Adalimumab was discontinued, and the patient was treated with pulse corticosteroid therapy with full vision recovery. Uveitis remained in remission. Follow-up MRI of the brain after six months showed marked resolution of the demyelinating lesions. The findings suggested that the demyelination was due to autoimmune encephalitis as a side effect of adalimumab, rather than sequelae of multiple sclerosis or an infectious process.
Conclusion
Adalimumab can induce severe demyelinating conditions in pediatric uveitis patients, especially in specific HLA positive patients. Early recognition, drug discontinuation, and prompt treatment are essential for full recovery and improved outcomes. Physicians should be cautious when using adalimumab in patients with autoimmune diseases.
Conflict of interest
No
1
Last name
BURGIC
Initials of first name(s)
SS
Department
Eye Clinic, University Clinical Center of Republic of Srpska
City
Banja Luka
Country
Bosnia and Herzegovina
2
Last name
Smoljanovic Skocic
Initials of first name(s)
S
Department
King Khalid Hail Hospital
City
Hail
Country
Saudi Arabia
3
Last name
Markic
Initials of first name(s)
B
Department
Eye Clinic, University Clinical Center of Republic of Srpska
City
Banja Luka
Country
Bosnia and Herzegovina
4
Last name
Mavija
Initials of first name(s)
M
Department
Eye Clinic, University Clinical Center of Republic of Srpska
City
Banja Luka
Country
Bosnia and Herzegovina
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