Multiple Sclerosis-Associated Uveitis: A Case Report of Refractory Bilateral Chronic Granulomatous Panuveitis Successfully Treated with Tocilizumab

ABSTRACT

Purpose

To report a case of uveitis associated with multiple sclerosis (MS) that was refractory to multiple lines of therapy but achieved remission with tocilizumab.

Methods

We conducted a retrospective analysis of the patient’s medical record including clinical, biological and imaging data.

Results

A 33-year-old female patient with a history of MS inactive for 5 years on teriflunomide, and no significant medical or ophthalmological history, presented with bilateral granulomatous panuveitis. Initial examination revealed a visual acuity of 0.4 logMAR and 1.3 logMAR in the right eye and the left eye, respectively, along with a significant anterior chamber flare in both eyes, posterior synechiae, large granulomatous keratic precipitates, bilateral vitritis, bilateral macular edema with foveolar pigment epithelial detachment, and significant bilateral venous and arterial vasculitis. The patient underwent several lines of treatment, all of which proved unsuccessful, including corticosteroids alone or in combination with azathioprine, methotrexate, and mycophenolate mofetil. As a final therapeutic option, tocilizumab was initiated, leading to the remission of uveitis. One year later, the uveitis remained inactive under a 5 mg/day prednisone regimen.

Conclusions

Tocilizumab appears to be an efficient option for managing uveitis associated with MS and may be a valuable choice for clinicians dealing with such cases.

KEYWORDS:

• Multiple sclerosis
• multiple sclerosis-associated uveitis
• tocilizumab
• uveitis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author’s contributions

WG collected the data. WG and LT contributed equally to the redaction of the manuscript. Data analysis was made by WG. WG and LT take responsibility for the integrity and accuracy of the data. LT, HL and CT participated in the clinical management of the patients enrolled in the study. All authors revised the manuscript. All authors have read and approved the final manuscript.

Availability of data and material

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Consent for publication

Due to the retrospective nature of the study, a written consent was not required, according to French law.