Tuberculous uveitis after treatment with etanercept.
BACKGROUND
Etanercept is a tumor necrosis factor (TNF) inhibitor that has been licensed in the United States for the treatment of adult and juvenile rheumatoid arthritis as well as psoriatic arthritis. Reactivation of tuberculosis is a complication of its use. We report the first case of tuberculous uveitis due to etanercept.


METHODS
We performed a clinical chart review.


METHODS
A 58-year-old Caucasian woman was referred to our hospital for chronic unilateral granulomatous panuveitis of the right eye (RE). She was on etanercept and methotrexate for rheumatoid arthritis. Since the patient was immunosuppressed with etanercept and since the uveitis was granulomatous we considered tuberculosis as a possible etiology. An aqueous humor tap was performed and sent for polymerase chain reaction analyses of Herpes simplex, Herpes zoster, and Mycobacterium tuberculosis (MT). This last test was positive. Another aqueous humor sample was taken and sent for microscopic examination of sputum for acid-fast bacilli and culture, both of which were positive for MT. A diagnosis of tuberculous uveitis was established; the patient was treated with rifampin, isoniazid pyrazinamide, and ethambutol and etanercept was stopped. Four months later there were no cells in the anterior chamber and the vitreous was clear.


CONCLUSIONS
To our knowledge this is the first reported case of tuberculous uveitis following treatment with etanercept. This etiology has to be considered in patients taking this drug who present with intraocular inflammation.
Fonollosa
Alex
A
Hospital Vall d'Hebron, Barcelona, Spain. 36427afc@combs.es
Segura
Antonio
A
Giralt
Joan
J
Garcia-Arumi
Jose
J
D018501:Antirheumatic Agents / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000382:microbiology; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D004359:Drug Therapy, Combination; D000068800:Etanercept; D005260:Female; D006099:Granuloma / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D007538:Isoniazid / Q000627:therapeutic use; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D015864:Panuveitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D011718:Pyrazinamide / Q000627:therapeutic use; D018124:Receptors, Tumor Necrosis Factor; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D014392:Tuberculosis, Ocular / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
D018501:Antirheumatic Agents; D000995:Antitubercular Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D011718:Pyrazinamide; D000068800:Etanercept; D007538:Isoniazid; D012293:Rifampin