Systemic Lupus Erythematosus-associated Retinal Vasculitis Treated with Adalimumab

ABSTRACT

Purpose

To present a case of refractory systemic lupus erythematosus (SLE)-associated retinal vasculitis that responded to the anti-tumor necrosis factor (TNF)-alpha inhibitor adalimumab as corticosteroid-sparing therapy.

Methods

Descriptive case report of a patient with SLE with retinal vasculitis complicated by an ischemic retinal vein occlusion and cystoid macular edema.

Results

A 30-year-old female patient with a history of SLE presented with retinal vasculitis and an ischemic, branch retinal vein occlusion with macular edema in the left eye. Oral corticosteroid was administered along with mycophenolate mofetil (MMF) as a corticosteroid-sparing agent. Despite MMF therapy, the patient developed an exacerbation of her vasculitis with the involvement of both eyes. Adalimumab was initiated with a resultant resolution of retinal vasculitis as a corticosteroid-sparing strategy with over 2 years of follow-up.

Conclusion

Anti-TNF-alpha therapy with adalimumab may be effective as a corticosteroid-sparing agent in select patients with ocular inflammation associated with SLE.

KEYWORDS:

• Adalimumab
• biologics
• immunosuppression
• retinal vasculitis
• systemic lupus erythematosus

Declaration of interest

The authors declare that there is no conflict of interest.

Financial support

This project was supported by unrestricted departmental grant from Research to Prevent Blindness, Inc. to the Emory Eye Center, Emory University School of Medicine, National Eye Institute/National Institutes of Health core grant P30-EY06360 (Department of Ophthalmology, Emory University School of Medicine), National Eye Institute of the National Institutes of Health under award number K23 EY030158 (Shantha) and R01 EY029594 (Yeh). This project is also supported by the Association for Research in Vision and Ophthalmology Mallinckrodt Young Investigator Grant (Yeh). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.

Additional information

Funding

This work was supported by the Association for Research in Vision and Ophthalmology [Mallinckrodt Young Investigator Grant (Yeh)]; National Eye Institute [R01 EY029594, K23 EY030158, P30-EY06360]; Researchto Prevent Blindness [Unrestricted department grant to Emory Eye Center], Bayer Global Ophthalmology Awards Program (Yeh, Shantha).