Asymptomatic choroidal tubercle in a patient with Crohn's disease on adalimumab treatment

Abstract

Introduction: Adalimumab, an anti-tumour necrosis factor alpha therapy for active Crohn's disease (CD), is associated with increased risks of tuberculosis infection.

Case report: The case is presented of a 48 year-old male with active CD on treatment with adalimumab. After three months, he developed a miliary pulmonary tuberculosis infection, with a solitary non-reactive choroidal tubercle temporal-superior to the optic disc being found in an ophthalmological study. Fluorescein angiography showed late hyperfluorescence in a staining pattern. Optic coherence tomography showed a flat mass without serous retinal detachment. The choroidal tubercle slowly regressed with antituberculosis therapy.

Discussion: Choroidal tubercles with no vitreo-retinal symptomatology can be present in patients with CD and on treatment with adalimumab.

Keywords: Adalimumab; Biological therapy; Choroidal tubercle; Crohn's disease; Enfermedad de Crohn; Miliary tuberculosis; Terapia biológica; Tuberculosis miliar; Tubérculo coroideo.