Tocilizumab Reactions 1680, p323 - 2 Dec 2017 Nodular scleritis: case report A 48-year-old woman developed anterior nodular scleritis following initiation of tocilizumab therapy for rheumatoid arthritis (RA). The woman had a history of RA, pyoderma gangrenosum, and systemic lupus erythematosus. Although, she had been treated with rituximab, methotrexate, sulfasalazine, hydroxychloroquine, and folic acid, her RA remained in active state. Therefore, her treatment was changed to IV tocilizumab 8 mg/kg every four weeks. Rituximab and methotrexate were discontinued prior to initiating tocilizumab. After the first dose of tocilizumab, clinical remission of her RA was noted, with a 28 joint Disease Activity Score of 2.41 as compared to previous score of 6.28. Additionally, the CRP decreased to < 1 from 28. Emergence of a lesion in an eye was noted subsequent to the second dose of tocilizumab. The lesion was diagnosed as nodular scleritis and the woman was treated with tapering dose of prednisone with clinical response. Tocilizumab was discontinued simultaneously and complete resolution of the nodular lesion was noted at nine months, without steroids. No other signs of intraocular inflammation were noted on ophthalmological examination using the slit-lamp. A tuberculosis blood test, full blood count and Treponema screen were performed to exclude infectious aetiology. It was postulated that this was a paradoxical effect of the tocilizumab treatment, provided that she had no previous incident of extra-articular manifestations, her inflammatory profile was suppressed, and considering the temporal relationship with initiation of tocilizumab. The woman did not accept the offer for tocilizumab re- challenge. Author comment: "[Tocilizumab] is an anti–IL-6 receptor monoclonal antibody, thereby conferring its antiinflammatory properties through this mechanism." "We conclude that ocular manifestations as a result of IL-6 inhibition should be considered as a possible paradoxical phenomenon when treating inflammatory arthritis." Michael E, et al. Paradoxical nodular scleritis during tocilizumab therapy: A case report. The Journal of Rheumatology 44: 1760-1761, No. 11, 01 Nov 2017. Available from: URL: - New Zealand 803285040 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680 Reactions Weekly Springer Journals


Reactions Weekly , Volume 1680 (1) – Dec 2, 2017
1 page

Loading next page...
1 Page
Springer International Publishing
Copyright © 2017 by Springer International Publishing AG, part of Springer Nature
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
Publisher site
See Article on Publisher Site


You’re reading a free preview. Subscribe to read the entire article.

DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 12 million articles from more than
10,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Unlimited reading

Read as many articles as you need. Full articles with original layout, charts and figures. Read online, from anywhere.

Stay up to date

Keep up with your field with Personalized Recommendations and Follow Journals to get automatic updates.

Organize your research

It’s easy to organize your research with our built-in tools.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

Monthly Plan

  • Read unlimited articles
  • Personalized recommendations
  • No expiration
  • Print 20 pages per month
  • 20% off on PDF purchases
  • Organize your research
  • Get updates on your journals and topic searches


Start Free Trial

14-day Free Trial

Best Deal — 39% off

Annual Plan

  • All the features of the Professional Plan, but for 39% off!
  • Billed annually
  • No expiration
  • For the normal price of 10 articles elsewhere, you get one full year of unlimited access to articles.



billed annually
Start Free Trial

14-day Free Trial