PARADOXICAL EXACERBATION OF SCLEROUVEITIS AFTER RITUXIMAB INFUSION

To report on an unexpected side effect of rituximab, a B-cell-targeting monoclonal agent, in a patient with severe sclerouveitis, leading to severe visual loss.

Observational case report.

A 61-year-old female patient was treated with rituximab for a severe sclerouveitis occurring with granulomatosis with polyangiitis. Initially, sclerouveitis responded partly to a high dose of oral corticosteroids. However, her sclerouveitis recurred after 2 months during tapering below 20 mg daily. The days following the rituximab infusions, aggravation of the intraocular inflammation was seen, endangering visual acuity. No evidence for an infection or other cause was found. High doses of oral corticosteroids were started within one week, whereafter the ocular inflammation resolved. For persisting hypotony and chorioretinal detachment, a combined pars plana vitrectomy with phacoemulsification and silicone oil tamponade was performed. The retina remained attached under oil tamponade with partial improvement of the best-corrected visual acuity to finger counting.

Ophthalmologist should be aware of the possibility of this paradoxical local reaction to rituximab infusion, particularly in bilateral and/or severe cases, which carry a risk of a poor outcome.