Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.
Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
Ocul Immunol Inflamm. 2022 May 19;30(4):839-844. doi: 10.1080/09273948.2020.1834588. Epub 2020 Nov 20.
Tumor necrosis factor inhibitors (anti-TNF) have emerged as an effective treatment in noninfectious uveitis (NIU). Anti-TNF may increase the predisposition to infectious disease as tuberculosis (TB). TB-related uveitis in the context of an uveitogenic concurrent systemic immune-mediated disease under anti-TNF treatment remain a diagnostic challenge, deserving special focus on this rare context. Retrospective chart review of patients on anti-TNF drugs for systemic immune-mediated diseases that developed a multicentric microbiologically confirmed active TB with concurrent intraocular involvement.Three patients were recorded. Screening for TB before starting anti-TNF resulted negative in two patients. The other patient had received anti-tuberculous treatment in the past. All showed a microbiologically confirmed extraocular TB after unexpected atypical reactivation of the uveitis shifting to chronic granulomatous pattern.Specialists should be aware of TB reactivation, even with previous negative screening, when ocular uveitis signs and activity do not match with the expected pattern in a patient on anti-TNF drugs.
肿瘤坏死因子抑制剂（抗 TNF）已成为治疗非感染性葡萄膜炎（NIU）的有效方法。抗 TNF 可能会增加结核病（TB）等传染病的易感性。在抗 TNF 治疗下，与葡萄膜炎相关的同时存在的全身免疫介导性疾病仍然是一个诊断挑战，在这种罕见的情况下值得特别关注。对接受抗全身免疫介导性疾病的 TNF 药物治疗后出现多灶性微生物学确诊的活动性 TB 并伴有眼内受累的患者进行回顾性图表审查。共记录了 3 名患者。在开始使用抗 TNF 之前，有 2 名患者的 TB 筛查结果为阴性。另一名患者过去曾接受过抗结核治疗。所有患者在眼葡萄膜炎出现意外非典型复发后，均出现了微生物学确诊的眼外 TB，转为慢性肉芽肿性模式。当接受抗 TNF 药物治疗的患者的眼部葡萄膜炎体征和活动与预期模式不匹配时，专家应注意 TB 再激活，即使之前的筛查结果为阴性。
