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Tuberculosis-Related Uveitis in Patients under Anti-TNF-alpha Therapy: A Case Series
I Hernanz1, L Miguel Escuder1, L Chamorro1
1Hospital Clinic of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.
Ocular Immunology and Inflammation
|November 20, 2020
Summary
Tumor necrosis factor inhibitors treat noninfectious uveitis but can reactivate tuberculosis (TB). Even with negative screening, TB reactivation is a risk in patients on anti-TNF therapy experiencing atypical uveitis.
Area of Science:
- Ophthalmology
- Immunology
- Infectious Diseases
Background:
- Noninfectious uveitis (NIU) is effectively treated with tumor necrosis factor inhibitors (anti-TNF).
- Anti-TNF therapy can increase susceptibility to infections, notably tuberculosis (TB).
- Diagnosing TB-related uveitis in patients with concurrent immune-mediated diseases on anti-TNF poses a significant challenge.
Purpose of the Study:
- To highlight the diagnostic challenges and clinical presentation of TB reactivation in patients with noninfectious uveitis treated with anti-TNF therapy.
Main Methods:
- Retrospective chart review of patients treated with anti-TNF for systemic immune-mediated diseases.
- Analysis of cases with microbiologically confirmed active TB and concurrent intraocular involvement.
Main Results:
- Three patients with microbiologically confirmed extraocular TB and intraocular involvement were identified.
- Two patients had negative TB screening before anti-TNF initiation; one had prior TB treatment.
- All patients experienced atypical uveitis reactivation with a shift to a chronic granulomatous pattern.
Conclusions:
- Ophthalmologists and specialists must consider TB reactivation in patients on anti-TNF therapy presenting with atypical uveitis, even if initial TB screening was negative.
- Awareness of TB reactivation is crucial when uveitis signs and activity deviate from expected patterns in patients receiving anti-TNF treatment.
- This rare context of TB-related uveitis requires heightened clinical suspicion and diagnostic vigilance.
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