Sarcoid-associated bilateral multifocal choroiditis secondary to adalimumab

Carl Stanley Wilkins, Kristen Taylor Ashourian, Ethan Kyle Sobol, Matthew Fink, Brian Saltzman, Steven Teich

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)205-208
Number of pages4
JournalJournal of Current Ophthalmology
Issue number2
StatePublished - Apr 1 2021
Externally publishedYes


  • Adalimumab
  • Drug reaction
  • Multifocal choroiditis
  • Sarcoidosis
  • Tumor necrosis factor alpha inhibitor
  • Uveitis

ASJC Scopus subject areas

  • Ophthalmology


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