title: Retinal vasculitis: a novel paradoxical effect of anti-TNFα?
abstract: Retinal vasculitis (RV) is extremely rare in spondyloarthritis associated with Crohn's disease. Infliximab, a chimeric monoclonal antibody to tumour necrosis factor (TNF) α, is efficient in spondyloarthritis, Crohn's disease and RV. We present the case of a 41-year-old man with a known history of spondyloarthritis associated with Crohn's disease. He was under treatment with infliximab. Four days after his 12th infusion of infliximab, he presented with sudden blurred vision. Although his disease was in remission, ophthalmological examination revealed bilateral peripheral retinal occlusive vasculitis. The patient responded positively to the treatment by laser photocoagulation and peribulbar corticosteroid injection. Infliximab was not stopped. There was improvement in his eye disease. To the best of our knowledge, this is the first case of new onset of RV occurring under infliximab in a patient with Crohn's related spondyloarthritis. This case illustrates the possibility of a paradoxical effect of this kind of therapy.
authors.affiliation: Department of Rheumatology, Mongi Slim Hospital, La Marsa, Tunisia.
authors.forename: Kaouther
authors.initials: K
authors.lastname: Ben Abdelghani
authors.affiliation: Department of Rheumatology, Mongi Slim Hospital, La Marsa, Tunisia.
authors.forename: Maroua
authors.initials: M
authors.lastname: Slouma
authors.affiliation: Department of Ophthalmology, Hospital of internal security forces, La Marsa, Tunisia.
authors.forename: Wady
authors.initials: W
authors.lastname: Ben Jalel
authors.affiliation: Department of Rheumatology, Mongi Slim Hospital, La Marsa, Tunisia.
authors.forename: Leith
authors.initials: L
authors.lastname: Zakraoui
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D000069285:Infliximab; D017075:Laser Coagulation; D008297:Male; D031300:Retinal Vasculitis / Q000175:diagnosis / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab