Uveitis in a patient treated with Bacille-Calmette-Guérin: possible antigenic mimicry of mycobacterial and retinal antigens.
OBJECTIVE
To investigate the cellular immune response in uveitis developing after intravesical Bacille-Calmette-Guérin (BCG) applications.


METHODS
Experimental study.


METHODS
A 72-year-old HLA-B27-negative patient with bilateral granulomatous anterior uveitis that developed during the third cycle of intravesical BCG applications she was receiving for treatment of bladder carcinoma.


METHODS
The patient's peripheral T cell reactivity to ocular autoantigens was compared with the response to purified protein derivative (PPD) from Mycobacterium tuberculosis. T-cell proliferation and cytokine and chemokine secretion were measured in vitro.


METHODS
Anterior uveitis was treated successfully with topical corticosteroids and cycloplegics.


RESULTS
The following were demonstrated: proliferation to PPD, interphotoreceptor retinoid-binding protein (IRBP), and IRBP-peptide R16, as well as secretion of proinflammatory cytokines in response to PPD, retinal soluble antigen (S-Ag), IRBP, cellular retinal-binding protein (CRALBP), and some S-Ag and IRBP peptides.


CONCLUSIONS
These data indicate the generation of a polyclonal autoimmune reaction elicited by BCG. Amino acid sequence alignments revealed homologies between proteins from M. tuberculosis, BCG, and retinal antigens, suggesting antigenic mimicry as a potential cause of uveitis in this patient.
Garip
Aylin
A
Section of Immunobiology, Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
Diedrichs-Möhring
Maria
M
Thurau
Stephan R
SR
Deeg
Cornelia A
CA
Wildner
Gerhild
G
D000368:Aged; D000595:Amino Acid Sequence; D000942:Antigens, Bacterial / Q000276:immunology*; D001324:Autoantigens / Q000276:immunology*; D001500:BCG Vaccine / Q000009:adverse effects* / Q000276:immunology; D016207:Cytokines / Q000378:metabolism; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D015796:HLA-B27 Antigen / Q000276:immunology; D006801:Humans; D007111:Immunity, Cellular; D007167:Immunotherapy; D008213:Lymphocyte Activation / Q000187:drug effects; D018716:Molecular Mimicry / Q000276:immunology*; D008969:Molecular Sequence Data; D009161:Mycobacterium / Q000276:immunology*; D009184:Mydriatics / Q000627:therapeutic use; D012160:Retina / Q000276:immunology*; D017386:Sequence Homology, Amino Acid; D013601:T-Lymphocytes / Q000276:immunology; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy; D014606:Uveitis, Anterior / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology
D000942:Antigens, Bacterial; D001324:Autoantigens; D001500:BCG Vaccine; D016207:Cytokines; D005938:Glucocorticoids; D015796:HLA-B27 Antigen; D009184:Mydriatics