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.