Case

The second patient was a 21-year-old male, with a 4-year history of ABD, who presented with a bilateral panuveitis relapse. Despite combination treatment with cyclosporine A (3 mg/kgr/day), azathioprine (2mg/kgr/day), and prednisolone (0.2-0.3 mg/kgr/day), he suffered from recurrent episodes of ocular inflammation. During the last year prior to infliximab administration, 11 such episodes had occurred. At his last ocular relapse (day 0) we decided to treat him with infliximab. Remicade® was administrated intravenously at a dose of 5 mg/kg at day 1, day 30, and every 8 weeks therafter. In addition to visual acuity evaluation, a standard scoring system was used to assess the presence of inflammatory cells in anterior chamber (on a scale from 0 to 4), the presence of vitreous haze (on a scale from 0-3), and retinal involvement (presence of vasculitis and number of retinal lesions). As shown in Table 1, the acute response to infliximab treatment was a dramatic improvement of ocular inflammation within 48 hours, and the resolution of symptoms within 7 days. The resolution of vitreous haze and of a retinal lesion following infliximab administration is depicted in Fig. 1.

Figure 1. Resolution of vitreous haze and a retinal lesion after infliximab therapy. Significant (2+) vitreous haze (A) and retinal lesion in the mid-periphety (D) of the right eye before infliximab administration. Vitreous haze has decreased (1+) at day 1 (B) and cleared at day 7 (C). The retinal lesion has diminished by 50% at day 1 (E) and is barely detectable at day 7 (F).

Figure 1. Resolution of vitreous haze and a retinal lesion after infliximab therapy. Significant (2+) vitreous haze (A) and retinal lesion in the mid-periphety (D) of the right eye before infliximab administration. Vitreous haze has decreased (1+) at day 1 (B) and cleared at day 7 (C). The retinal lesion has diminished by 50% at day 1 (E) and is barely detectable at day 7 (F).

Infliximab proved efficacious in the long term; the patient is in remission ever since the first infusion. The evaluation of visual acuity, and ocular inflammation score during treatment is shown in Table 1. Moreover, prednisolone was tapered and withdrawn in the 9th month of infliximab treatment, whereas azathioprine and cyclosporine A were both withdrawn within 7 and 14 months, respectively. For the last 2 months the patient was only receiving infliximab. During monotherapy with infliximab, the patient's overall clinical status remained stable. Infliximab administration was well tolerated and no adverse events were noted.

Table 1. Visual acuity and ocular score of inflammation at panuveitis relapse (day 0), and 1,4, 14, 28 days up to 16 months after the initiation of infliximab therapy

Visual Acuity

Anterior Chamber Cells (0 - 4) L R

Vitreous Haze (0-3)

Vasculitis

Retinal

Lesions (number) L R

Visual Acuity

Anterior Chamber Cells (0 - 4) L R

Vitreous Haze (0-3)

Retinal

Lesions (number) L R

Day 0

0.4

0.2

1

2

1

2

+

+

1

3

Day 1

0.5

0.5

Trace

Trace

0

1

+

+

1

I

Day 4

0.8

0,6

0

0

0

Trace

-

-

0

0

Day 14

I

0,7

0

0

0

0

-

-

0

0

Day 28

1

0.8

0

0

0

0

-

-

0

0

Months

!

0.8

0

0

0

0

-

-

0

0

2-16

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