ABSTRACT
Dupilumab, the first biologic approved for treatment of atopic dermatitis, has demonstrated significant clinical effect and quality of life-enhancing capacity in clinical trials. In these, dupilumab-associated conjunctivitis where reported in a minority of patients. The present case series describe 10 patients treated with dupilumab where eye complications were very common. We have described patient characteristics, including FLG mutations, atopic history and clinical effect of dupilumab. Nine of 10 developed eye-complications, most commonly conjunctivitis (in 7/10). Other adverse events were herpes simplex virus uveitis and varicella-zoster virus meningitis. Although our case series is small, we conclude that dupilumab is an effective treatment option in severe atopic dermatitis, but that the risk of adverse events from the eyes and recurrence of herpes virus infections should be kept in mind. Close collaboration with an ophthalmologist is recommended, especially among patients with severe, long-lasting atopic dermatitis and/or previous eye disease.
Subject(s)
Antibodies, Monoclonal/adverse effects , Biological Products/adverse effects , Conjunctivitis/chemically induced , Dermatitis, Atopic/drug therapy , Adult , Antibodies, Monoclonal, Humanized , Conjunctivitis/diagnosis , Conjunctivitis/immunology , Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/immunology , Eye Infections, Viral/chemically induced , Eye Infections, Viral/immunology , Female , Filaggrin Proteins , Herpes Simplex/chemically induced , Herpes Simplex/immunology , Herpes Simplex/virology , Herpes Zoster/chemically induced , Herpes Zoster/immunology , Herpes Zoster/virology , Humans , Immunocompromised Host , Male , Meningitis, Viral/chemically induced , Meningitis, Viral/immunology , Meningitis, Viral/virology , Middle Aged , Opportunistic Infections/chemically induced , Opportunistic Infections/immunology , Opportunistic Infections/virology , Risk Assessment , Risk Factors , Severity of Illness Index , Treatment Outcome , Uveitis, Anterior/chemically induced , Uveitis, Anterior/immunology , Uveitis, Anterior/virology , Young AdultABSTRACT
A 60-year-old diabetic patient, who had undergone a renal transplant 2 years earlier, presented with sudden decrease in vision in his left eye (LE). He had undergone phacoemulsification combined with intravitreal dexamethasone implant injection in his LE 2 months earlier, for coexistent cataract and diabetic macular edema. Examination revealed necrotizing retinitis with hemorrhages in the macula. A diagnosis of cytomegalovirus retinitis was made, which was confirmed on vitreous polymerase chain reaction. Intravitreal and systemic ganciclovir led to the resolution of retinitis and improvement of visual acuity over a follow-up of 9 months.
Subject(s)
Cytomegalovirus Retinitis/chemically induced , Dexamethasone/adverse effects , Diabetic Retinopathy/drug therapy , Eye Infections, Viral/chemically induced , Macular Edema/drug therapy , Phacoemulsification/methods , Cytomegalovirus Retinitis/diagnosis , Diabetic Retinopathy/diagnosis , Drug Implants , Eye Infections, Viral/diagnosis , Glucocorticoids/administration & dosage , Glucocorticoids/adverse effects , Humans , Macular Edema/diagnosis , Male , Middle Aged , Visual AcuityABSTRACT
PURPOSE: To demonstrate a patient developing multiple bilateral eyelid molluscum contagiosum lesions after initiation of TNFalpha-antibody therapy for rheumatoid arthritis. DESIGN: Single interventional case report. METHODS: Clinical, histopathologic, and immunologic-serological findings are presented. RESULTS: A 67-year-old patient with a 5-year history of rheumatoid arthritis had been treated with prednisone and methotrexate for the last 5 years. After initiation of additional TNFalpha-antibody treatment, complaints from rheumatoid arthritis subsided, but multiple bilateral molluscum contagiosum lesions of upper and lower eyelids occurred despite normal or only slightly reduced CD(4) (420-178/ microl) and CD(8) counts (143-58/microl). Histopathologic evaluation of the excised warts confirmed the clinical diagnosis. Under continued therapy, the warts have been recurring for 12 months. CONCLUSION: TNFalpha-antibody treatment for rheumatoid arthritis may compromise the host response to molluscum contagiosum, especially if methotrexate is given additionally. Patients should be informed about this potential complication.
