Kim Minji Jennifer, Jones Nicholas, Steeples Laura R
Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
BMJ Case Rep. 2018 Dec 4;11(1):e226772. doi: 10.1136/bcr-2018-226772.
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.
肿瘤坏死因子-α（TNF-α）是非感染性葡萄膜炎（NIU）中的关键促炎细胞因子。阿达木单抗是一种抗TNF-α单克隆抗体，已被欧洲药品管理局批准用于治疗重度NIU。在系统性免疫介导疾病的抗TNF-α治疗期间，存在包括结核病（TB）在内的严重感染的公认风险。我们描述了在阿达木单抗治疗重度NIU期间发生的粟粒性肺结核。据我们所知，这是葡萄膜炎患者中该并发症的首例详细报告。我们提出了在危及生命的感染期间管理威胁视力的葡萄膜炎的挑战，这需要停用阿达木单抗和口服免疫抑制治疗。在抗结核治疗期间，通过口服糖皮质激素治疗控制了葡萄膜炎活动。
