title: Orbital Cellulitis in a Psoriatic Patient Treated With Adalimumab.
abstract: Psoriatic patients on tumor necrosis factor alpha inhibitors (TNFi) may be at increased risk for upper respiratory tract infections, including chronic rhino-sinusitis (CRS). Rarely, CRS can progress to orbital cellulitis (OC), an emergent ophthalmic complication wherein respiratory flora from paranasal sinus disease intrude the retro-orbital space.
  
  
  
  Single case report.
  
  
  
  We report the first case, to our knowledge, of an invasive sinusitis that rapidly evolved into OC in a patient receiving adalimumab treatment for plaque psoriasis and psoriatic arthritis. After TNFi withdrawal and appropriate medical and surgical intervention, the patient fully recovered. However, on resumption of TNFi therapy, symptoms of recalcitrant CRS returned.
  
  
  
  More investigation is needed to explore how TNFi might predispose to chronic, refractory rhino-sinusitis and subsequent progression to OC. Military physicians and other medical providers should be aware of this proposed new disease entity and the potential for rapidly evolving and invasive infections in immunocompromised patients. Screening and monitoring for chronic infectious disease, such as CRS before initiating and during TNFi therapy is warranted.
authors.affiliation: USS Somerset (LPD-25), Medical Department, Naval Base San Diego, FPO AP 96678-1709, San Diego, CA 92113.
authors.forename: Vienna G
authors.initials: VG
authors.lastname: Katana
authors.affiliation: Department of Aerospace, Internal Medicine and Infectious Diseases, Naval Aerospace Medical Institute, 340 Hulse Road, Pensacola, FL 32508.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Carpenter
authors.affiliation: Department of Dermatology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134.
authors.forename: John P
authors.initials: JP
authors.lastname: Trafeli
authors.affiliation: Department of Dermatology, Naval Health Clinic Hawaii, 480 Central Avenue, Pearl Harbor, HI 96869.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Kwan
mesh_terms: D000068879:Adalimumab / Q000494:pharmacology / Q000627:therapeutic use; D000328:Adult; D015535:Arthritis, Psoriatic; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006192:Haemophilus Infections / Q000175:diagnosis; D006193:Haemophilus influenzae / Q000472:pathogenicity; D006801:Humans; D008297:Male; D054517:Orbital Cellulitis / Q000150:complications* / Q000175:diagnosis; D010146:Pain / Q000209:etiology; D040141:Staphylococcaceae / Q000472:pathogenicity; D013207:Staphylococcal Skin Infections / Q000175:diagnosis; D013289:Streptococcaceae / Q000472:pathogenicity; D013290:Streptococcal Infections / Q000175:diagnosis; D014057:Tomography, X-Ray Computed / Q000379:methods; D014786:Vision Disorders / Q000209:etiology
chemical_list: D000068879:Adalimumab