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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
CASE REPORT
Miliary tuberculosis developing during adalimumab treatment for Behçet’s disease with uveitis
  1. Minji Jennifer Kim,
  2. Nicholas Jones and
  3. Laura R Steeples
  1. Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
  1. Correspondence to Minji Jennifer Kim, jennifer.kim{at}doctors.org.uk

Abstract

Tumour necrosis factor-alpha (TNF-α) is a key proinflammatory cytokine in non-infective uveitis (NIU). Adalimumab, an anti-TNF-α monoclonal antibody, is approved for the treatment of severe NIU by the European Medicines Agency. There is a recognised risk of serious infections, including tuberculosis (TB), during anti-TNF-α therapy in systemic immune-mediated diseases. We describe miliary pulmonary TB during adalimumab therapy for severe NIU. To our knowledge, this is the first detailed report of this complication in a patient with uveitis. We present the challenges of managing vision-threatening uveitis during life-threatening infection necessitating withdrawal of adalimumab and oral immunosuppression therapy. Uveitis activity was controlled during anti-TB therapy with oral corticosteroid therapy.

  • biological agents
  • unwanted effects / adverse reactions
  • retina

https://doi.org/10.1136/bcr-2018-226772

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    Footnotes

    • Contributors All authors contributed equally to this work. MJK, LRS and NJ conducted case review. MJK wrote the main paper, and LRS and NJ wrote the online supplementary information. All authors discussed the results and implications and commented on the manuscript at all stages.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.