Anterior uveitis secondary to type II essential cryoglobulinemia

Abstract

BackgroundThe purpose of this report is to describe the association of severe anterior uveitis with type II essential cryoglobulinemia.FindingsA 40-year-old male with a history of psoriatic arthritis presented with severe anterior uveitis associated with type II essential cryoglobulinemia. His uveitis, refractory to steroid treatments, was well controlled following treatments for cryoglobulinemia. The temporal association between his cryoglobulinemia and uveitis, combined with his improved visual acuity and inflammation after plasmapheresis and rituximab infusions, suggests cryoglobulinemia to be the underlying condition of his uveitis.ConclusionsTo our best knowledge, this is the first reported case of anterior uveitis secondary to type II essential cryoglobulinemia.

Non-anti-TNF biologic modifier drugs in non-infectious refractory chronic uveitis: The current evidence from a systematic review

“…However, our strategy research was able to identify 5 additional children, who experienced sustained improvement of uveitis after the specific NTT treatment, thus supporting our results: 2 children, 1 boy with Blau syndrome [24] and 1 with juvenile Behçet's disease [25], received canakinumab; 1 girl with JIA received abatacept [26]; and 1 boy with CINCA syndrome anakinra [27] and another 1 with JIA received tocilizumab [28]. With regard to adults, rituximab has been reported to maintain remission in a patient with Behçet's disease retinal vasculitis and related posterior uveitis [29] and in a 40-year-old male suffering from anterior uveitis secondary to type II essential cryoglobulinemia [30] at 24-and 6-month follow-up, respectively. Alejandre et al [31] reported the favorable outcome of chronic refractory uveitis in 2 members of a family with cryopyrin-associated periodic syndrome after starting anakinra, and, eventually, Oshitari et al [32] reported resolution of uveitis at 3 months after treatment with tocilizumab in a 58-year-old man with Castleman disease.…”

Extensive choroidal infarction in a case of mixed essential cryoglobulinaemia in a postpartum female

“…Ocular involvement in cryoglobulinaemia is rare and has been seen as retinal vascular occlusion,2 anterior uveitis,5 corneal deposits,6 central serous chorioretinopathy and pigment epithelial detachment,7 8 rubeosis,9 scleritis and peripheral ulcerative keratitis10 and even orbital inflammation 11. Commonly postulated hypothesis for these ocular findings includes ischaemia secondary to paraproteinemia-related hyperviscosity, cryoglobulin-induced inflammation and occlusive phenomenon due to the unusual temperature-dependent globulin solubility 2–11.…”

Plasmapheresis in Ophthalmology

“…Conventional immunosuppressive therapy and cytotoxic drugs do not prevent recurrent exacerbations and complex treatment with plasmapheresis provides more stable results [69,103]. Plasmapheresis is used in combination with blood cells ozonation [104]. Plasmapheresis or plasma exchange with replacement of the autologous cryosorbed plasma up to 50% of the circulating plasma volume contribute to a faster resolution of the inflammatory process, transition to remission state, disappearance of adhesions even without local proteolytic treatment [105].…”