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Miliary tuberculosis developing during adalimumab treatment for Behçet's disease with uveitis
Minji Jennifer Kim1, Nicholas Jones1, Laura R Steeples1
1Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
BMJ Case Reports
|December 21, 2018
Summary
Adalimumab treats severe non-infective uveitis (NIU) but carries infection risks. This report details miliary pulmonary tuberculosis during adalimumab therapy for NIU, highlighting management challenges.
Area of Science:
- Ophthalmology
- Immunology
- Infectious Diseases
Background:
- Non-infective uveitis (NIU) is often managed with biologic therapies targeting proinflammatory cytokines.
- Tumour necrosis factor-alpha (TNF-α) inhibitors, like adalimumab, are effective but associated with serious infection risks, including tuberculosis (TB).
Observation:
- This report details a rare case of miliary pulmonary tuberculosis occurring in a patient undergoing adalimumab therapy for severe NIU.
- This represents the first documented instance of this specific complication in a patient with uveitis.
Findings:
- Management of vision-threatening NIU during active, life-threatening TB infection required adalimumab and immunosuppression withdrawal.
- Uveitis control was achieved with oral corticosteroids during anti-tuberculosis treatment.
Implications:
- Clinicians should maintain a high index of suspicion for TB in NIU patients on anti-TNF-α therapy.
- Careful risk-benefit assessment and vigilant monitoring are crucial for patients receiving adalimumab for NIU, especially in TB-endemic areas.