Sasajima Hirofumi, Yagi Syunsuke, Osada Hiromu, Zako Masahiro
Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan.
Department of Ophthalmology, Asai Hospital, 178-1 Yakata-cho, Seto, Aichi, 489-0866, Japan.
J Med Case Rep. 2017 May 4;11(1):124. doi: 10.1186/s13256-017-1288-1.
Injections of lipopolysaccharide in animal models generate acute anterior uveitis (also known as endotoxin-induced uveitis), but the effects of lipopolysaccharide injection are unknown in humans. We describe an unusual case in which acute anterior uveitis was dramatically activated subsequent to botulinum toxin injection in a patient with Behçet's disease but the acute anterior uveitis was satisfactorily attenuated by infliximab.
A 53-year-old Japanese man had normal ocular findings at his regularly scheduled appointment. He had been diagnosed as having incomplete-type Behçet's disease 11 years before. Three years after the diagnosis he was given systemic infusions of 5 mg/kg infliximab every 8 weeks and he had not experienced a uveitis attack for 8 years with no treatment other than infliximab. Two days after the eye examination, he received intracutaneous botulinum toxin injections to treat axillary hyperhidrosis on both sides. Three hours after the injections, he noted rapidly increasing floaters in his right eye. Four days after the injections, his right eye showed severe acute anterior uveitis with deteriorated aqueous flare and anterior vitreous opacity. He received his scheduled infliximab injection, and the right acute anterior uveitis immediately attenuated.
Botulinum toxin may have clinical effects similar to those of lipopolysaccharide in endotoxin-induced uveitis models. To the best of our knowledge, this is the first report to suggest that botulinum toxin may trigger acute anterior uveitis, although the precise mechanism is still unclear.
在动物模型中注射脂多糖可引发急性前葡萄膜炎（也称为内毒素诱导的葡萄膜炎），但脂多糖注射在人类中的作用尚不清楚。我们描述了一例不寻常的病例，一名白塞病患者在注射肉毒杆菌毒素后急性前葡萄膜炎显著激活，但英夫利昔单抗使其急性前葡萄膜炎得到了满意的缓解。
一名53岁的日本男性在定期预约检查时眼部检查结果正常。他在11年前被诊断为不完全型白塞病。诊断后3年，他每8周接受一次5mg/kg英夫利昔单抗的全身输注，除英夫利昔单抗外未接受其他治疗，8年来未发生葡萄膜炎发作。眼部检查两天后，他接受了皮内肉毒杆菌毒素注射以治疗双侧腋窝多汗症。注射后3小时，他注意到右眼的飞蚊症迅速增加。注射后4天，他的右眼出现严重的急性前葡萄膜炎，房水闪光和前部玻璃体混浊加重。他接受了预定的英夫利昔单抗注射，右眼的急性前葡萄膜炎立即得到缓解。
在毒素诱导的葡萄膜炎模型中，肉毒杆菌毒素可能具有与脂多糖类似的临床作用。据我们所知，这是第一份表明肉毒杆菌毒素可能引发急性前葡萄膜炎的报告，尽管确切机制仍不清楚。
