Atypical Ocular Toxoplasmosis During Adalimumab Anti–Tumor Necrosis Factor Therapy for Rheumatoid Arthritis

Walkden, Andrew; Wig, Surabhi; Bhatt, Priya; Jones, Nicholas P.; Steeples, Laura R

doi:10.1097/rhu.0000000000001124

Cited by 9 publications

(6 citation statements)

References 5 publications

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“…The patient initially responded to antitoxoplasma treatment but developed a severe recurrence six months later, leading to permanent vision loss to hand movements. 9 Unlike other cases reported in the literature, the location of chorioretinitis in our patient was away from the posterior pole. Toxoplasmosis involving peripheral retina is not typical but has been reported widely in the literature.…”

Section: Declaration Of Conflicting Interestscontrasting

confidence: 64%

“…5,6 In total, five reports describing five patients of ocular toxoplasmosis following anti-TNF-α agents are available in literature (Table 1). [7][8][9][10] To the best of our knowledge, no such report has been available from India. Also, ours is the first report of ocular toxoplasmosis in patients with JIA, a condition where anti-TNF-α agents are used frequently worldwide.…”

Section: Discussionmentioning

confidence: 99%

“…PCR from ocular fluid may be useful in such a situation. 9 There may be considerable variations in the presentation of ocular toxoplasmosis lesions in such immunosuppressive patients receiving anti-TNF-α therapy. According to a report by Walkden et al, an 86-year-old woman presented with a large area of necrotizing retinitis in the superotemporal retina following treatment with adalimumab.…”

Section: Declaration Of Conflicting Interestsmentioning

confidence: 99%

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Ocular toxoplasmosis following anti-tumour necrosis factor-α therapy combined with oral methotrexate therapy: A case report and review of literature

Patnaik,

Pyare,

Kaushik

et al. 2023

European Journal of Ophthalmology

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Purpose: To report a case of ocular toxoplasmosis following long-term treatment with adalimumab and review the literature on ocular toxoplasmosis following anti-Tumour necrosis factor-α therapy. Method: A retrospective chart review of A 21-year-old male who developed retinochoroiditis in his left eye following adalimumab therapy combined with oral methotrexate. Result: A known patient of juvenile idiopathic arthritis (JIA) on adalimumab and oral methotrexate for the last four years presented to us with a blurring of vision for the last 15 days. Fundus examination of the left eye revealed severe vitritis and two patches of retinochoroiditis in the inferior part of the fundus. Subsequent investigations confirmed it to be a case of toxoplasma retinochoroiditis, and he responded to anti-toxoplasma treatment. A review of literature on a similar topic revealed five such cases, and the index case was the first such report in patients with JIA. Conclusion: The index case highlights the importance of early recognition and management of opportunistic infections in patients receiving biologicals.

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Section: Declaration Of Conflicting Interestscontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Declaration Of Conflicting Interestsmentioning

confidence: 99%

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Ocular toxoplasmosis following anti-tumour necrosis factor-α therapy combined with oral methotrexate therapy: A case report and review of literature

Patnaik,

Pyare,

Kaushik

et al. 2023

European Journal of Ophthalmology

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“…Similar to the patient in this case report, these patients were all HIV-negative and had no other risk factors affecting their immune systems. Three of these case reports had eye involvement and six cases had neurologic manifestations [5][6][7][8][9][10][11][12]. Of the nine case reports reviewed, seven were on tumor necrosis factor inhibitors at the time of toxoplasmosis diagnosis [5][6][7][8]11,12].…”

Section: Discussionmentioning

confidence: 99%

“…Three of these case reports had eye involvement and six cases had neurologic manifestations [ 5 - 12 ]. Of the nine case reports reviewed, seven were on tumor necrosis factor inhibitors at the time of toxoplasmosis diagnosis [ 5 - 8 , 11 , 12 ]. Only one case report described treatment with methotrexate alone [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Cerebral Toxoplasmosis in a Rheumatoid Arthritis Patient on Immunosuppressive Therapy

Hill

Wyatt

Ennis³

2020

Cureus

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Cerebral toxoplasmosis is a life-threatening infection most commonly found in immunocompromised hosts such as acquired immunodeficiency syndrome (AIDS) or transplant patients. However, it is not known to affect patients with chronic inflammatory disorders on immunosuppressive therapy. We describe the case of a 70-year-old female with rheumatoid arthritis (RA) on chronic therapy with methotrexate and infliximab, who presented to the hospital after two weeks of right-sided weakness. Imaging revealed bilateral ring-enhancing lesions in the basal ganglia (left greater than right). A diagnosis of cerebral toxoplasmosis was made on brain biopsy. Apart from the immunosuppressive therapy and owning a cat, she had no other risk factors for developing the infection. The patient's immunosuppressive medications were discontinued, and she was started on high-dose trimethoprimsulfamethoxazole (TMP-SMX). Upon literature review using PubMed, we found seven other published reports on similar cases of toxoplasmosis in RA patients on immunosuppressive therapy; however, there was a lack of recommendations for diagnosis, treatment, and prophylaxis in this patient population. With the growing use of immunosuppressive therapies in chronic inflammatory disorders, further data is needed regarding the management of toxoplasmosis in these patients. This case report is an investigation of the relationship between immunosuppressive medications in RA patients and cerebral toxoplasmosis and an exploration of the available recommendations for its management.

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Toxoplasmosis

Montoya¹,

Contopoulos‐Ioannidis²

2021

Neglected Tropical Diseases

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Atypical Ocular Toxoplasmosis During Adalimumab Anti–Tumor Necrosis Factor Therapy for Rheumatoid Arthritis

Cited by 9 publications

References 5 publications

Ocular toxoplasmosis following anti-tumour necrosis factor-α therapy combined with oral methotrexate therapy: A case report and review of literature

Ocular toxoplasmosis following anti-tumour necrosis factor-α therapy combined with oral methotrexate therapy: A case report and review of literature

Cerebral Toxoplasmosis in a Rheumatoid Arthritis Patient on Immunosuppressive Therapy

Toxoplasmosis

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