Adalimumab Monotherapy in the Treatment of Idiopathic Multifocal Choroiditis: A Case Report
In this study, we report a case of multifocal choroiditis that was successfully treated with adalimumab monotherapy. A 25-year-old male presented with a history of bilateral multifocal choroiditis which was resistant to a combination of azathioprine, valacyclovir, and prednisone. Dilated fundoscopy...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2022-11-01
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| Series: | Case Reports in Ophthalmology |
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| Online Access: | https://www.karger.com/Article/FullText/525504 |
| _version_ | 1828098087877345280 |
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| author | Arash Maleki Andrew Philip C. Stephen Foster |
| author_facet | Arash Maleki Andrew Philip C. Stephen Foster |
| author_sort | Arash Maleki |
| collection | DOAJ |
| description | In this study, we report a case of multifocal choroiditis that was successfully treated with adalimumab monotherapy. A 25-year-old male presented with a history of bilateral multifocal choroiditis which was resistant to a combination of azathioprine, valacyclovir, and prednisone. Dilated fundoscopy revealed small creamy-yellow lesions around the arcades in both eyes (OU). Indocyanine green angiography (ICGA) revealed active hypocyanescent lesions around the arcades and macula OU. Valacyclovir was stopped, adalimumab subcutaneous injections biweekly were added to the regimen, and prednisone was tapered after the second adalimumab loading dose. At 3-month follow-up, ocular examination and ICGA were unremarkable OU. After 30 months of remission, azathioprine was tapered and stopped. After 40 months of remission, adalimumab was tapered and stopped. Four months after stopping adalimumab injections, the patient returned with new floaters in his right eye (OD). ICGA and macular optical coherence tomography detected active lesions OU. The patient was restarted on adalimumab subcutaneous injections as monotherapy. At 3-month follow-up visit, his symptoms had resolved, and ICGA showed resolution of the lesions OD and improvement of the lesions in the left eye (OS). He has been in remission for 6 months at the time of writing since restarting adalimumab monotherapy. We conclude from this study that long-term adalimumab monotherapy can be employed effectively and safely in the re-treatment of patients with multifocal choroiditis resistant to other immunomodulatory therapy even after successful tapering and discontinuation of concurrent therapies. |
| first_indexed | 2024-04-11T07:57:11Z |
| format | Article |
| id | doaj.art-a4128113091f404386db61b6e6ec2a10 |
| institution | Directory Open Access Journal |
| issn | 1663-2699 |
| language | English |
| last_indexed | 2024-04-11T07:57:11Z |
| publishDate | 2022-11-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Ophthalmology |
| spelling | doaj.art-a4128113091f404386db61b6e6ec2a102022-12-22T04:35:54ZengKarger PublishersCase Reports in Ophthalmology1663-26992022-11-0113380880810.1159/000525504525504Adalimumab Monotherapy in the Treatment of Idiopathic Multifocal Choroiditis: A Case ReportArash Maleki0https://orcid.org/0000-0001-5533-9798Andrew Philip1C. Stephen Foster2Massachusetts Eye Research and Surgery Institution, Waltham, MA, USAMassachusetts Eye Research and Surgery Institution, Waltham, MA, USAMassachusetts Eye Research and Surgery Institution, Waltham, MA, USAIn this study, we report a case of multifocal choroiditis that was successfully treated with adalimumab monotherapy. A 25-year-old male presented with a history of bilateral multifocal choroiditis which was resistant to a combination of azathioprine, valacyclovir, and prednisone. Dilated fundoscopy revealed small creamy-yellow lesions around the arcades in both eyes (OU). Indocyanine green angiography (ICGA) revealed active hypocyanescent lesions around the arcades and macula OU. Valacyclovir was stopped, adalimumab subcutaneous injections biweekly were added to the regimen, and prednisone was tapered after the second adalimumab loading dose. At 3-month follow-up, ocular examination and ICGA were unremarkable OU. After 30 months of remission, azathioprine was tapered and stopped. After 40 months of remission, adalimumab was tapered and stopped. Four months after stopping adalimumab injections, the patient returned with new floaters in his right eye (OD). ICGA and macular optical coherence tomography detected active lesions OU. The patient was restarted on adalimumab subcutaneous injections as monotherapy. At 3-month follow-up visit, his symptoms had resolved, and ICGA showed resolution of the lesions OD and improvement of the lesions in the left eye (OS). He has been in remission for 6 months at the time of writing since restarting adalimumab monotherapy. We conclude from this study that long-term adalimumab monotherapy can be employed effectively and safely in the re-treatment of patients with multifocal choroiditis resistant to other immunomodulatory therapy even after successful tapering and discontinuation of concurrent therapies.https://www.karger.com/Article/FullText/525504adalimumabazathioprinemultifocal choroiditisprimary inflammatory choriocapillaropathy |
| spellingShingle | Arash Maleki Andrew Philip C. Stephen Foster Adalimumab Monotherapy in the Treatment of Idiopathic Multifocal Choroiditis: A Case Report Case Reports in Ophthalmology adalimumab azathioprine multifocal choroiditis primary inflammatory choriocapillaropathy |
| title | Adalimumab Monotherapy in the Treatment of Idiopathic Multifocal Choroiditis: A Case Report |
| title_full | Adalimumab Monotherapy in the Treatment of Idiopathic Multifocal Choroiditis: A Case Report |
| title_fullStr | Adalimumab Monotherapy in the Treatment of Idiopathic Multifocal Choroiditis: A Case Report |
| title_full_unstemmed | Adalimumab Monotherapy in the Treatment of Idiopathic Multifocal Choroiditis: A Case Report |
| title_short | Adalimumab Monotherapy in the Treatment of Idiopathic Multifocal Choroiditis: A Case Report |
| title_sort | adalimumab monotherapy in the treatment of idiopathic multifocal choroiditis a case report |
| topic | adalimumab azathioprine multifocal choroiditis primary inflammatory choriocapillaropathy |
| url | https://www.karger.com/Article/FullText/525504 |
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