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Acute anterior uveitis after discontinuation of tocilizumab in a patient with rheumatoid arthritis

BACKGROUND: Tocilizumab is a humanized monoclonal anti-interleukin-6 (IL-6) receptor antibody and has been approved in Japan for the treatment of Castleman’s disease, rheumatoid arthritis (RA), and systemic juvenile idiopathic arthritis. Conjunctivitis and dry eye are known ocular adverse effects, b...

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Autores principales: Sato, Tomohito, Minakuchi, Shinya, Mochizuki, Manabu, Takeuchi, Masaru
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891663/
https://www.ncbi.nlm.nih.gov/pubmed/24531503
http://dx.doi.org/10.2147/OPTH.S54929
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author Sato, Tomohito
Minakuchi, Shinya
Mochizuki, Manabu
Takeuchi, Masaru
author_facet Sato, Tomohito
Minakuchi, Shinya
Mochizuki, Manabu
Takeuchi, Masaru
author_sort Sato, Tomohito
collection PubMed
description BACKGROUND: Tocilizumab is a humanized monoclonal anti-interleukin-6 (IL-6) receptor antibody and has been approved in Japan for the treatment of Castleman’s disease, rheumatoid arthritis (RA), and systemic juvenile idiopathic arthritis. Conjunctivitis and dry eye are known ocular adverse effects, but uveitis has not been reported. CASE REPORT: A 72-year-old woman had undergone bilateral cataract surgery without complications. Six months after the surgery, she was diagnosed with RA and treated with tocilizumab infusion every 4 weeks. However, severe malaise and dizziness occurred after the third tocilizumab infusion, and the treatment was suspended. Since the symptoms associated with RA had resolved, she was followed without any medication thereafter. At 5 weeks after the third tocilizumab infusion, she developed severe anterior inflammation with hypopyon in her left eye, and her visual acuity dropped to less than 2/200. Considering her age and history of cataract surgery, endophthalmitis was suspected and a vitrectomy was performed, but no pathogens were detected from the intraocular fluid samples collected during surgery. The ocular inflammation was gradually resolved with systemic antibiotics and corticosteroids. However, severe anterior uveitis recurred in the same eye during the tapering of the systemic corticosteroids, when the aqueous humor IL-6 level was 46,100 pg/mL. The recurrent ocular inflammation was resolved with increased doses of topical and systemic corticosteroids, and the patient has since remained relapse-free. No symptom of inflammation was observed in the right eye during the follow-up period. CONCLUSION: This case indicates a possibility that acute anterior uveitis may have been an adverse effect after the discontinuation of anti-IL-6 receptor antibody therapy in a patient with RA.
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spelling pubmed-38916632014-01-27 Acute anterior uveitis after discontinuation of tocilizumab in a patient with rheumatoid arthritis Sato, Tomohito Minakuchi, Shinya Mochizuki, Manabu Takeuchi, Masaru Clin Ophthalmol Case Report BACKGROUND: Tocilizumab is a humanized monoclonal anti-interleukin-6 (IL-6) receptor antibody and has been approved in Japan for the treatment of Castleman’s disease, rheumatoid arthritis (RA), and systemic juvenile idiopathic arthritis. Conjunctivitis and dry eye are known ocular adverse effects, but uveitis has not been reported. CASE REPORT: A 72-year-old woman had undergone bilateral cataract surgery without complications. Six months after the surgery, she was diagnosed with RA and treated with tocilizumab infusion every 4 weeks. However, severe malaise and dizziness occurred after the third tocilizumab infusion, and the treatment was suspended. Since the symptoms associated with RA had resolved, she was followed without any medication thereafter. At 5 weeks after the third tocilizumab infusion, she developed severe anterior inflammation with hypopyon in her left eye, and her visual acuity dropped to less than 2/200. Considering her age and history of cataract surgery, endophthalmitis was suspected and a vitrectomy was performed, but no pathogens were detected from the intraocular fluid samples collected during surgery. The ocular inflammation was gradually resolved with systemic antibiotics and corticosteroids. However, severe anterior uveitis recurred in the same eye during the tapering of the systemic corticosteroids, when the aqueous humor IL-6 level was 46,100 pg/mL. The recurrent ocular inflammation was resolved with increased doses of topical and systemic corticosteroids, and the patient has since remained relapse-free. No symptom of inflammation was observed in the right eye during the follow-up period. CONCLUSION: This case indicates a possibility that acute anterior uveitis may have been an adverse effect after the discontinuation of anti-IL-6 receptor antibody therapy in a patient with RA. Dove Medical Press 2014-01-08 /pmc/articles/PMC3891663/ /pubmed/24531503 http://dx.doi.org/10.2147/OPTH.S54929 Text en © 2014 Sato et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Case Report
Sato, Tomohito
Minakuchi, Shinya
Mochizuki, Manabu
Takeuchi, Masaru
Acute anterior uveitis after discontinuation of tocilizumab in a patient with rheumatoid arthritis
title Acute anterior uveitis after discontinuation of tocilizumab in a patient with rheumatoid arthritis
title_full Acute anterior uveitis after discontinuation of tocilizumab in a patient with rheumatoid arthritis
title_fullStr Acute anterior uveitis after discontinuation of tocilizumab in a patient with rheumatoid arthritis
title_full_unstemmed Acute anterior uveitis after discontinuation of tocilizumab in a patient with rheumatoid arthritis
title_short Acute anterior uveitis after discontinuation of tocilizumab in a patient with rheumatoid arthritis
title_sort acute anterior uveitis after discontinuation of tocilizumab in a patient with rheumatoid arthritis
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891663/
https://www.ncbi.nlm.nih.gov/pubmed/24531503
http://dx.doi.org/10.2147/OPTH.S54929
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