On 2021/06/25, the patient presented with complaints of right-sided chest pain, headache, and dizziness. Vitals were within normal limits. General and systemic examinations were unremarkable. Baseline investigations, including complete blood count, renal function test, liver function test, serum electrolytes, urine routine and microscopic, and chest X-ray, showed normal findings. Creatinine phosphokinase (CPK-MB) was 18 IU/L, and Troponin-I was negative. C - reactive protein was positive (63.18 mg/L), and Erythrocyte Sedimentation Rate was 40 mm/hr, possibly indicating the active stage of the disease. After that, a Non-Contrast CT head and High-Resolution CT chest were done, which were normal. Ear, Nose, and Throat (ENT) consultation was done for dizziness, but they suggested no possible middle ear causes. His headache was associated with throbbing eyeball pain. On ophthalmologic consultation, peripheral choroiditis and vitritis were noted with normal intraocular pressure and visual acuity. Oral prednisolone 50 mg once daily was started and tapered over several days. Likewise, atropine and prednisolone eye drops were also prescribed. During the hospital stay, the visual acuity deteriorated, and IOP also increased. Oral acetazolamide was started, and IOP gradually decreased to the normal range. Visual acuity was not significantly improved till discharge.

The patient also developed pain and tingling sensation over the left half of the head, face, and neck. In between, he was referred to a rheumatologist, who recommended the use of adalimumab. Sputum smear for acid-fast bacilli, Mantoux test, and chest X-ray were done to rule out tuberculosis. Similarly, liver function tests, viral markers, and ultrasound abdomen were performed to rule out viral hepatitis. Finally, the first and second dose of adalimumab 40mg subcutaneously on an interval of fifteen days was administered, and the patient was discharged and advised to follow up after two weeks. His ocular symptoms have improved on follow-up examination.