Arteritic anterior ischemic optic neuropathy (AAION) in a patient with Crohn´s disease treated with Infliximab

Introduction: Giant Cell Arteritis (GCA) is a granulomatous and necrotizing inflammation of medium and large calibre arteries due to unknown etiology. Rapidly progressive loss of vision is one of the most serious complications given its irreversibility. Crohn´s disease (CD) is a segmental and transmural inflammation of the gastrointestinal tract. Both entities have a low impact in our environment and it is exceptional the coexistence of these conditions in the same patient. Clinical case: We present a 77 yeas-old woman with a personal history of CD in active treatment with Infliximab who showed a sudden visual loss in her left eye (LE). In the ophthalmological examination the visual acuity was counting fingers at 30 cm and we observed a very clear left relative afferent papillary defect. Fundus showed a papiledema with peripapillary haemorrhages. The patient reported symptoms and laboratory abnormalities compatibles with GCA, so after being diagnosed of arteritic anterior ischemic optic neuritis we proceeded to the administration of high doses of glucocorticoids leading to analytical and clinical improvement, although the visual loss was permanent. Conclusion: Infliximab is an anti-TNFα drug used in active CD in cases refractory to corticosteroid treatment, data suggest that may have a beneficial effect on GCA inhibition because TNFα participate in the pathogenesis of both diseases. However in our patient, it was not enough and she needed high doses of corticosteroids to avoid the bilateralism of the disease. Resumen Introducción: La arteritis de células gigantes (ACG) es una inflamación granulomatosa y necrotizante de arterias de mediano y gran calibre de etiología desconocida. La pérdida de visión rápidamente progresiva es una de sus complicaciones más graves dada su potencial bilateralidad e irreversibilidad. La enfermedad de Crohn (EC) es debida a la inflamación transmural y segmentaria del tracto gastrointestinal. Ambas entidades poseen una baja incidencia en nuestro medio, siendo excepcional la coexistencia de estas simultáneamente en el mismo paciente. Caso clínico: Mujer de 77 años de edad con antecedentes personales de EC en tratamiento activo con Infliximab que acudió por disminución súbita de agudeza visual (AV) por su ojo izquierdo (OI). A la exploración oftalmológica la AV por su OI era de cuenta dedos a 30 cm y mostraba un defecto pupilar aferente relativo izquierdo muy manifiesto. Funduscópicamente el OI mostró un edema de papila pálido con