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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Main Authors: Arash Maleki, Andrew Philip, C. Stephen Foster
Format: Article
Language:English
Published: Karger Publishers 2022-11-01
Series:Case Reports in Ophthalmology
Subjects:
Online Access:https://www.karger.com/Article/FullText/525504
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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.
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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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AT cstephenfoster adalimumabmonotherapyinthetreatmentofidiopathicmultifocalchoroiditisacasereport