Bilateral Retrobulbar Optic Neuropathy Associated With Golimumab.

We report the first documented case of retrobulbar optic neuropathy associated with golimumab. A 48-year-old man was admitted with a 3-week history of progressive visual loss of his left eye. He had received a second infusion of golimumab for ankylosing spondylitis 10 days before admission. A magnetic resonance imaging scan showed enhancement of both optic nerves and visual evoked potentials were consistent with demyelinating bilateral optic neuropathy, although visual acuity drop in the right eye could not be determined because of deep amblyopia. No improvement was observed after golimumab dechallenge or corticosteroid treatment. Demyelinating complications related to treatment with tumor necrosis factor alpha inhibitors (TNFAI) have been previously described. Golimumab, a fully human monoclonal antibody, is the most recently developed TNFAI and thus, fewer adverse effects have been reported. Further studies should be developed to elucidate if variability in golimumab's pharmacokinetics or TNF receptor binding affinity could explain different safety profiles compared with other TNFAI.

Categorización diagnóstica según los criterios del First International Workshop on Ocular Sarcoidosis (FIWOS) en una serie de 11 pacientes / Diagnostic categorization according to the First International Workshop on Ocular Sarcoidosis (FIWOS) criteria in a series of 11 patients

Objetivo. Categorizar a los pacientes con diagnóstico de sarcoidosis ocular en el período comprendido entre 2009 y 2014. Métodos. Se revisaron las historias clínicas de los pacientes con sarcoidosis ocular y se recopilaron las variables para categorizar a los pacientes según los criterios del FIWOS. Resultados. Se encontró a un total de 11 pacientes con uveítis sarcoidea, 7 mujeres y 4 hombres, con una mediana de edad de 58 años. El patrón de panuveítis bilateral crónica fue el más frecuente en un 54,5%, seguido de la uveítis anterior crónica unilateral, con 27,2%. El diagnóstico de sarcoidosis fue definitivo en 4 pacientes (36,3%), presunto en 5 pacientes (45,4%), probable en un paciente (9%) y posible en un paciente (9%). Conclusiones. Más de la mitad de los pacientes sin biopsia confirmatoria fueron diagnosticados de sarcoidosis ocular. La panuveítis bilateral crónica y la uveítis anterior crónica fueron los patrones predominantes (AU)

Objective. Categorization of patients diagnosed with ocular sarcoidosis during the period 2009-2014. Methods. The medical records of patients with ocular sarcoidosis were reviewed and variables were collected to categorize the patients according to the criteria of the FIWOS. Results. We found 11 patients, 7 women and 4 men, with sarcoid uveitis; the median age was 58 years. Bilateral panuveitis was the most common pattern (54.5%), followed by chronic anterior uveitis (27.2%). The diagnosis of sarcoidosis was definitive in 4 patients (36.3%), presumed in 5 (45.4%), probable in 1 (9%) and possible in 1 (9%). Conclusions. Ocular sarcoidosis was diagnosed in more than half of the patients who had no confirmatory biopsy. Bilateral panuveitis and chronic anterior uveitis were the patterns most frequently observed (AU)

Diagnostic categorization according to the First International Workshop on Ocular Sarcoidosis (FIWOS) criteria in a series of 11 patients. / Categorización diagnóstica según los criterios del First International Workshop on Ocular Sarcoidosis (FIWOS) en una serie de 11 pacientes.

OBJECTIVE: Categorization of patients diagnosed with ocular sarcoidosis during the period 2009-2014. METHODS: The medical records of patients with ocular sarcoidosis were reviewed and variables were collected to categorize the patients according to the criteria of the FIWOS. RESULTS: We found 11 patients, 7 women and 4 men, with sarcoid uveitis; the median age was 58 years. Bilateral panuveitis was the most common pattern (54.5%), followed by chronic anterior uveitis (27.2%). The diagnosis of sarcoidosis was definitive in 4 patients (36.3%), presumed in 5 (45.4%), probable in 1 (9%) and possible in 1 (9%). CONCLUSIONS: Ocular sarcoidosis was diagnosed in more than half of the patients who had no confirmatory biopsy. Bilateral panuveitis and chronic anterior uveitis were the patterns most frequently observed.

Colchicine use in isolated renal AA amyloidosis / Uso de colchicina en amiloidosis AA renal aislada

We present the case of a 45-year-old woman, with two-year history of chronic renal insufficiency and proteinuria. A kidney biopsy showed the presence of AA amyloidosis (positive Congo red staining and immunohistochemistry). There was no evidence of amyloid deposits in other organs and there was no underlying disease. AA amyloidosis normally is secondary to chronic inflammatory or infectious diseases. High levels of IL-1, IL-6 and TNF-α play a role in the pathogenesis of amyloidosis and induce the synthesis of serum amyloid A protein (SAA), a precursor of tissue amyloid deposits. We empirically treated the patient with a low dose colchicine. The patient responded well. Colchicine has been used for the treatment of Familiar Mediterranean Fever and related auto-inflammatory diseases. To monitor treatment responses, we measured SAA finding low titers. Soon after treatment onset there were signs of improvement pertaining to proteinuria and stabilization of renal function (AU)

Se presenta el caso de una paciente de 45 años de edad con insuficiencia renal crónica y proteinuria. La biopsia renal demostró una amiloidosis tipo AA con un estudio de extensión negativo para depósitos en otros órganos. No se detectó enfermedad asociada. La amiloidosis tipo AA se asocia habitualmente a una enfermedad crónica inflamatoria o infecciosa. Las interleucinas IL1, IL-6 y TNF son responsables de la síntesis hepática de la proteína sérica amiloide A (SAA), precursor del amiloide que se deposita en los tejidos. Ante la imposibilidad de tratar una amiloidosis sin evidencia de enfermedad subyacente, instauramos empíricamente tratamiento con colchicina con buenos resultados. La colchicina es eficaz para el tratamiento de la fiebre mediterránea familiar y otros procesos inflamatorios. Se midieron niveles de la SAA en sangre que inicialmente fueron muy elevados alcanzándose niveles normales al poco tiempo de tratamiento con mejoría de la proteinuria, manteniéndose estable la función renal (AU

Colchicine use in isolated renal AA amyloidosis.

We present the case of a 45-year-old woman, with two-year history of chronic renal insufficiency and proteinuria. A kidney biopsy showed the presence of AA amyloidosis (positive Congo red staining and immunohistochemistry). There was no evidence of amyloid deposits in other organs and there was no underlying disease. AA amyloidosis normally is secondary to chronic inflammatory or infectious diseases. High levels of IL-1, IL-6 and TNF-α play a role in the pathogenesis of amyloidosis and induce the synthesis of serum amyloid A protein (SAA), a precursor of tissue amyloid deposits. We empirically treated the patient with a low dose colchicine. The patient responded well. Colchicine has been used for the treatment of Familiar Mediterranean Fever and related auto-inflammatory diseases. To monitor treatment responses, we measured SAA finding low titers. Soon after treatment onset there were signs of improvement pertaining to proteinuria and stabilization of renal function.