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Infliximab-Associated Third Nerve Palsy
Fahhad I. Farukhi, MBA, MA;
Kathryn Bollinger, MD;
Paul Ruggieri, MD;
Michael S. Lee, MD
Arch Ophthalmol. 2006;124:1055-1057.
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A third nerve palsy (TNP) may show gadolinium enhancement of the cisternal segment of the oculomotor nerve on magnetic resonance imaging. Causes include inflammation, infection, neoplasm, ophthalmoplegic migraine, and demyelination. Infliximab, a tumor necrosis factor (TNF)  inhibitor, may cause demyelination or increase relapses in patients with multiple sclerosis.1 We report a patient who developed a TNP associated with infliximab use.
Report of a Case
A 47-year-old man with rheumatoid arthritis received monthly infusions of 300 mg of infliximab since December 2002. In February 2004, he was initially seen with painless ptosis of his right upper eyelid along with double vision in left and upgaze.
On examination, he had minimal ptosis and limitation of elevation and adduction of the right eye. Pupils were equal in size and reactivity. Visual acuity, dilated fundus examination, neurologic examination, and review of systems were . . . [Full Text of this Article]
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