Tuberculosis-Related Uveitis in Patients under Anti-TNF-alpha Therapy: A Case Series

ABSTRACT

Tumor necrosis factor inhibitors (anti-TNF) have emerged as an effective treatment in noninfectious uveitis (NIU). Anti-TNF may increase the predisposition to infectious disease as tuberculosis (TB). TB-related uveitis in the context of an uveitogenic concurrent systemic immune-mediated disease under anti-TNF treatment remain a diagnostic challenge, deserving special focus on this rare context. Retrospective chart review of patients on anti-TNF drugs for systemic immune-mediated diseases that developed a multicentric microbiologically confirmed active TB with concurrent intraocular involvement.

Three patients were recorded. Screening for TB before starting anti-TNF resulted negative in two patients. The other patient had received anti-tuberculous treatment in the past. All showed a microbiologically confirmed extraocular TB after unexpected atypical reactivation of the uveitis shifting to chronic granulomatous pattern.

Specialists should be aware of TB reactivation, even with previous negative screening, when ocular uveitis signs and activity do not match with the expected pattern in a patient on anti-TNF drugs.

KEYWORDS:

• Tuberculosis
• uveitis
• anti-TNF therapy
• latent tuberculosis infection
• adalimumab
• infliximab
• Behçet disease
• spondyloarthropaties
• ankylosing spondylitis
• Crohn’s disease

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.