Botulinum toxin-induced acute anterior uveitis in a patient with Behçet’s disease under infliximab treatment: a case report

Abstract

BackgroundInjections of lipopolysaccharide in animal models generate acute anterior uveitis (also known as endotoxin-induced uveitis), but the effects of lipopolysaccharide injection are unknown in humans. We describe an unusual case in which acute anterior uveitis was dramatically activated subsequent to botulinum toxin injection in a patient with Behçet’s disease but the acute anterior uveitis was satisfactorily attenuated by infliximab.Case presentationA 53-year-old Japanese man had normal ocular findings at his regularly scheduled appointment. He had been diagnosed as having incomplete-type Behçet’s disease 11 years before. Three years after the diagnosis he was given systemic infusions of 5 mg/kg infliximab every 8 weeks and he had not experienced a uveitis attack for 8 years with no treatment other than infliximab. Two days after the eye examination, he received intracutaneous botulinum toxin injections to treat axillary hyperhidrosis on both sides. Three hours after the injections, he noted rapidly increasing floaters in his right eye. Four days after the injections, his right eye showed severe acute anterior uveitis with deteriorated aqueous flare and anterior vitreous opacity. He received his scheduled infliximab injection, and the right acute anterior uveitis immediately attenuated.ConclusionsBotulinum toxin may have clinical effects similar to those of lipopolysaccharide in endotoxin-induced uveitis models. To the best of our knowledge, this is the first report to suggest that botulinum toxin may trigger acute anterior uveitis, although the precise mechanism is still unclear.

Rheumatoid Arthritis Induced by Botulinum Toxin Type A: A Case Report and Review of the Literature

“…Only one longitudinal study reported bone volume changes induced by BoNT/A. The remaining reports were not related to joints and bones [9][10][11][12][13][14][15][16][17][18][19]. To our knowledge, we are reporting the first case of rheumatoid arthritis caused by BoNT/A.…”

Late-onset bilateral epithelial ingrowth following rapid corneal decompensation owing to amantadine

“…One case report described acute anterior uveitis activated subsequent to BT injection in a patient with Behçet's disease, which was attenuated by infliximab. 5 However, no ocular side effects have been described from the combination of BT injections and intravenous natalizumab. It is possible that the BT injection inducing the myasthenic syndrome also induced a bilateral anterior uveitis, left undiagnosed owing to the long delay between the decrease in vision and the first eye exam (1 month).…”