Toriu Chika, Tsubota Kinya, Usui Yoshihiko, Goto Hiroshi
Department of Ophthalmology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan.
J Ophthalmic Inflamm Infect. 2023 Nov 28;13(1):52. doi: 10.1186/s12348-023-00375-w.
There is no consensus concerning restarting anti-tumour necrosis factor (TNF)-α therapy for uveitis after treatment for active tuberculosis (TB). We report a case of Behcet disease (BD) in which treatment with TNF inhibitor was successfully resumed after treatment for miliary TB.
A 48-year-old Japanese male was treated for uveitis of unknown aetiology in the left eye at a general ophthalmology clinic. He was referred to Department of Ophthalmology, Tokyo Medical University Hospital because of macula oedema (ME) not responding to prednisolone (PSL) 20 mg. BD was diagnosed based on fluorescein angiographic findings of diffuse retinal vasculitis characteristic of BD, recurrent oral aphthous ulcer, erythema nodosum-like rash in his legs, and HLA-A26 positivity. After a screening test, adalimumab (ADA) was started as steroid-sparing therapy. Eight months after starting ADA, the patient was diagnosed with miliary TB. ADA and PSL were discontinued immediately due to TB. Anti-TB treatment was completed after 6 months based on clinical improvement, although T-SPOT.TB was still positive. Infliximab with isoniazid was started due to relapse of ME, worsened vitreous haze, and worsened visual acuity in his left eye. Subsequently, his ocular symptoms subsided and there was no relapse of TB.
This case suggests that in patients with BD who have discontinued anti-TNF therapy due to miliary TB, restarting anti-TNF therapy may be a therapeutic option after TB has been treated appropriately with careful monitoring for relapse.
对于活动性肺结核（TB）治疗后葡萄膜炎重启抗肿瘤坏死因子（TNF）-α治疗，目前尚无共识。我们报告1例白塞病（BD）患者，其粟粒性结核治疗后成功恢复使用TNF抑制剂治疗。
一名48岁日本男性因左眼不明病因葡萄膜炎在综合眼科诊所接受治疗。因其黄斑水肿（ME）对20mg泼尼松龙（PSL）无反应，转诊至东京医科大学医院眼科。根据BD特征性的弥漫性视网膜血管炎的荧光素血管造影结果、复发性口腔溃疡、腿部结节性红斑样皮疹及HLA-A26阳性诊断为BD。筛查后，开始使用阿达木单抗（ADA）作为激素节省疗法。开始使用ADA 8个月后，患者被诊断为粟粒性结核。因结核停用ADA和PSL。基于临床改善，6个月后完成抗结核治疗，尽管结核感染T细胞检测（T-SPOT.TB）仍为阳性。因ME复发、左眼玻璃体混浊加重及视力下降，开始使用英夫利昔单抗联合异烟肼治疗。随后其眼部症状消退，结核未复发。
该病例提示，对于因粟粒性结核停用抗TNF治疗BD患者，在结核经适当治疗并仔细监测复发后，重启抗TNF治疗可能是一种治疗选择。
