title: Systemic adalimumab induces peripheral corneal infiltrates: a case report.
abstract: BACKGROUND
  Tumor necrosis factor-alpha inhibitors are widely used agents in the treatment of immune disorders such as rheumatoid arthritis and inflammatory bowel disease. Despite their anti-inflammatory action, paradoxical drug-induced inflammatory events have been occasionally associated with the use of infliximab, etanercept, and in a lesser extent adalimumab. However, eye involvement is uncommon and anterior uveitis is the only reported ocular adverse manifestation. It can be induced by etanercept, but has also been described during adalimumab therapy. We present here the first report of recurrent peripheral corneal infiltrates following subcutaneous injections of adalimumab.
  
  
  METHODS
  A 34 year-old Caucasian woman with Crohn's disease presented to the emergency department with bilateral red eyes and discomfort 36 hours after she received her bimonthly dose of subcutaneous adalimumab. Examination revealed bilateral peripheral corneal infiltrates with characteristic features of immune infiltrates. Symptoms and infiltrates regressed after topical corticosteroid therapy, but recurred after each adalimumab injection over the following weeks.
  
  
  CONCLUSIONS
  Paradoxical immune reactions associated with tumor necrosis factor-alpha inhibitors may result either from hypersensitivity mechanisms, or from immune-complex deposition via anti-adalimumab antibodies. Both mechanisms could explain this newly described manifestation. Care should be taken to search for corneal infiltrates in the event of red eye symptoms during adalimumab therapy since they respond to topical corticosteroids and do not necessarily prompt the discontinuation of the immunosuppressive therapy.
authors.affiliation: Department of Ophthalmology, Hotel-Dieu Hospital, AP-HP, and Sorbonne Paris Cité University, Paris Descartes faculty of medicine, 1 place du parvis Notre-Dame 75004, Paris, France. alexmatet@gmail.com.|Department of ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Avenue de France 15, 1004, Lausanne, Switzerland. alexmatet@gmail.com.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Matet
authors.affiliation: Department of Ophthalmology, Hotel-Dieu Hospital, AP-HP, and Sorbonne Paris Cité University, Paris Descartes faculty of medicine, 1 place du parvis Notre-Dame 75004, Paris, France. adaruich.matet@gmail.com.|Department of ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Avenue de France 15, 1004, Lausanne, Switzerland. adaruich.matet@gmail.com.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Daruich
authors.affiliation: Department of Ophthalmology, Hotel-Dieu Hospital, AP-HP, and Sorbonne Paris Cité University, Paris Descartes faculty of medicine, 1 place du parvis Notre-Dame 75004, Paris, France. talal.beydoun@hotmail.com.
authors.forename: Talal
authors.initials: T
authors.lastname: Beydoun
authors.affiliation: Department of Gastroenterology, Saint-Antoine Hospital, AP-HP, and Pierre et Marie Curie University, 184 rue du Faubourg Saint-Antoine 75012, Paris, France. jacques.cosnes@sat.aphp.fr.
authors.forename: Jacques
authors.initials: J
authors.lastname: Cosnes
authors.affiliation: Department of Ophthalmology, Hotel-Dieu Hospital, AP-HP, and Sorbonne Paris Cité University, Paris Descartes faculty of medicine, 1 place du parvis Notre-Dame 75004, Paris, France. drbourges@gmail.com.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bourges
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects*; D000287:Administration, Topical; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D003316:Corneal Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D003424:Crohn Disease / Q000188:drug therapy; D003907:Dexamethasone / Q000627:therapeutic use; D057915:Drug Substitution; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007279:Injections, Subcutaneous; D009883:Ophthalmic Solutions; D011245:Pregnadienes / Q000627:therapeutic use; D012008:Recurrence; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D009883:Ophthalmic Solutions; D011245:Pregnadienes; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha; D003907:Dexamethasone; D000068879:Adalimumab; C013769:rimexolone