Three cases of induction of scleritis as a paradoxical reaction to TNF inhibitor and CTLA4Ig
Purpose
Multiple paradoxical reactions to biological agents have been identified including ocular disease.
Methods
We report three cases of scleritis induced by a tumor necrosis factor(TNF) inhibitor and cytotoxic T-lymphocyte antigen 4(CTLA4Ig).
Results
A 64-year-old female patient had been receiving abatacept for rheumatoid arthritis. After 3 months, she developed diffuse scleritis with peripheral corneal infiltration, dacryoadenitis, blepharitis, and secondary glaucoma. Topical steroids were administered, and the symptoms resolved. She continues to receive abatacept.
A 76-year-old female patient developed pneumocystis pneumonia associated with abatacept. Abatacept was suspended for 18 months, and she developed diffuse scleritis. Abatacept was re-administered, but the scleritis worsened and was accompanied by macular edema. The biologic was switched from abatacept to golimumab, after which her scleritis and macular edema resolved completely.
A 44-year-old female patient had been receiving etanercept for rheumatoid arthritis. After 1 year, she developed diffuse scleritis. The biologic was switched from etanercept to tocilizumab, and her scleritis resolved immediately.
Conclusion
Scleritis as a paradoxical reaction can be induced by some types of biological agents. We reported three cases of scleritis presumably induced by the biologic. Scleritis resolved following administration of steroid therapy or switching the biologic.
Conflict of interest
No
Author 1
Last name
TAKEDA
Initials of first name(s)
A
Department
Nippon Medical School Tama-nagayama Hospital Ophthalmology
City
Tokyo
Country
Japan
Author 2
Last name
Yui
Initials of first name(s)
S
Department
Nippon Medical School Hospital Ophthalmology
City
Tokyo
Country
Japan
Author 3
Last name
Ogura
Initials of first name(s)
E
Department
Nippon Medical School Hospital Ophthalmology
City
Tokyo
Country
Japan
Author 4
Last name
Hori
Initials of first name(s)
J
Department
Nippon Medical School Tama-nagayama Hospital Ophthalmology
City
Tokyo
Country
Japan
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