Orbital Cellulitis in a Psoriatic Patient Treated With Adalimumab

Area of Science:

• Immunology
• Ophthalmology
• Infectious Disease

Background:

• Tumor necrosis factor alpha inhibitors (TNFi) are used to treat inflammatory conditions like psoriasis and psoriatic arthritis.
• Patients on TNFi may have a higher susceptibility to infections, including upper respiratory tract infections.
• Chronic rhino-sinusitis (CRS) is a potential complication, which can rarely progress to orbital cellulitis (OC).

Observation:

• A single case report details an invasive sinusitis rapidly progressing to orbital cellulitis (OC) in a patient treated with adalimumab (a TNFi) for plaque psoriasis and psoriatic arthritis.
• Following TNFi withdrawal and treatment, the patient recovered.
• Upon resuming TNFi therapy, the patient experienced a recurrence of refractory CRS.

Findings:

• This case suggests a potential link between TNFi therapy and the development of severe rhino-sinusitis.
• The recurrence of CRS symptoms after TNFi re-initiation indicates a possible role of TNFi in disease persistence or exacerbation.
• Orbital cellulitis is a rare but serious complication that can arise from invasive sinusitis in immunocompromised patients.

Implications:

• Further research is necessary to elucidate the mechanisms by which TNFi may contribute to chronic rhino-sinusitis and its progression to orbital cellulitis.
• Healthcare providers, particularly military physicians, should be vigilant for this potential association in immunocompromised patients.
• Screening for and monitoring chronic infectious diseases, such as CRS, is advisable before and during TNFi treatment to mitigate risks.