Tocilizumab in Recalcitrant Bilateral Scleritis in a Case of Relapsing Polychondritis: A 17-year Follow Up

ABSTRACT

Purpose

To report a challenging case of relapsing polychondritis with bilateral diffuse scleritis, with 17-year follow-up.

Methods

Case report

Results

A 36-year-old female presented 17 years ago with bilateral diffuse scleritis and peripheral corneal infiltrates. Detailed systemic work-up was negative. Fourteen months later, she developed saddle nose deformity, debilitating myalgias, and severe recurrence of scleritis clinching the diagnosis of relapsing polychondritis. Despite high-dose oral corticosteroids, oral immunosuppressants, and cyclophosphamide infusions and adalimumab infusions, the condition showed waxing and waning over the next decade. In 2017, she was started on Tocilizumab injections after which both the systemic and ocular conditions stabilised and has been remained stable for the past 4 years.

Conclusion

Relapsing polychondritis has a well-known association with scleritis. The ocular disease may precede systemic symptoms in some cases. Newer agent such as tocilizumab appears to be effective in controlling this relentless and recurrent disease.

KEYWORDS:

• Management
• necrotizing scleritis
• peripheral ulcerative keratitis
• relapsing polychondritis
• tocilizumab

Consent to publish statement

The authors confirm that the consent to publish has been obtained from the patient

Disclosure statement

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

Additional information

Funding

For Dr Doctor and Dr Murthy: Hyderabad Eye Research Foundation, Hyderabad.