title: Orbital Relapsing Polychondritis: A Unique Presentation, Complication, and Treatment.
abstract: An 87-year-old man with a history of relapsing polychondritis presented to the emergency department after 4 days of worsening left periorbital swelling and erythema. On examination, he demonstrated clinical features consistent with orbital cellulitis and was treated with a trial of intravenous antibiotics. His condition did not improve over the next 36 hours and intravenous methylprednisolone was initiated. This led to rapid improvement in orbital symptoms and signs, and a diagnosis of specific orbital inflammation secondary to relapsing polychondritis was made. The patient was discharged on a tapering dose of prednisone. As a steroid-sparing measure, adalimumab was initiated; however, the patient developed Sweet Syndrome. Adalimumab was subsequently discontinued, steroid dose was increased, and anakinra treatment was initiated. This therapeutic course led to significant clinical improvement. Since initiating anakinra, the patient has had no recurrences of Sweet Syndrome. Anakinra may be a useful adjunct therapy for ophthalmic manifestations of relapsing polychondritis.
authors: Department of Oculoplastic Surgery, Jules Stein Eye Institute, UCLA, Los Angeles, CA, U.S.A.
authors: Grant H
authors: GH
authors: Moore
authors: Daniel B
authors: DB
authors: Rootman
authors: C Nathaniel
authors: CN
authors: Roybal
authors: Robert A
authors: RA
authors: Goldberg
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects / Q000627:therapeutic use; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D053590:Interleukin 1 Receptor Antagonist Protein / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D054517:Orbital Cellulitis / Q000175:diagnosis* / Q000188:drug therapy; D011081:Polychondritis, Relapsing / Q000175:diagnosis* / Q000188:drug therapy; D016463:Sweet Syndrome / Q000139:chemically induced / Q000188:drug therapy
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D053590:Interleukin 1 Receptor Antagonist Protein; D000068879:Adalimumab; D008775:Methylprednisolone