A case of Crohn’s disease presenting with acute bilateral visual loss and literature review

Abstract The purpose of this study was to report a case of bilateral visual loss due to presumed optic neuropathy resulting from Crohn’s disease (CD) or medication used for treatment. A 45-year-old woman with a history of CD and associated cytomegalovirus colitis was lost to follow-up. She presented with progressively painless dimmer vision and experienced intolerable abdominal pain with bloody stool. She developed bilateral visual field defects after 10 days of three infliximab pills use. The fundoscopic examination and optical coherent tomography results were unremarkable except for the constricted visual field in both eyes. Brain computed tomography results were also negative. The patient’s vision worsened to only light perception in both eyes within 11 days after the second infliximab administration. Imaging showed patent carotid and ophthalmic arteries with bilateral optic nerve hyperintensity on diffusion-weighted imaging but no T2-weighted or postcontrast T1-weighted abnormalities. Given the potential association between bilateral retrobulbar optic neuropathy and infliximab, infliximab use was discontinued. High-dose intravenous methylprednisolone was administered and then substituted with prednisolone after 3 days, at which point the patient’s visual acuity had markedly improved. Optic neuritis is an ocular sign of inflammatory bowel disease and can be caused by the disease itself or appear as a side effect of antitumor necrosis factor-alpha (anti-TNF-α) agents such as infliximab. Physicians should be aware of ocular complications and treatment measures, including immediate steroid pulse therapy and timely discontinuation of medications containing anti-TNF-α agents, which could contribute to better visual outcomes.