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Ma D, Xiao C, Zhao D, Li G, Cheng W, Deng X, He D, Liu K. Posterior scleritis following a single infusion of zoledronate for osteoporosis: A case report and literature review. Clin Case Rep 2024; 12:e9068. [PMID: 38855089 PMCID: PMC11161269 DOI: 10.1002/ccr3.9068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 05/30/2024] [Indexed: 06/11/2024] Open
Abstract
The most frequently reported adverse reaction to zoledronic acid is an acute phase reaction resembling influenza. While rarer adverse events such as osteonecrosis of the jaw and atypical femoral fractures have gained significant recognition, the ocular adverse effects, particularly scleritis, are not yet fully comprehended. Here, we present the case of a 75-year-old female patient with osteoporosis who developed bilateral redness and intense eye pain 48 h after receiving a 5 mg intravenous dose of zoledronic acid. Clinical presentation suggested bilateral conjunctivitis, but treatment with levofloxacin eye drops and acyclovir ophthalmic gel exacerbated the symptoms over 2 days, predominantly affecting the left eye. Ocular ultrasonography revealed thickening of the left eyeball wall with a "T" sign, while an orbital CT scan showed increased thickness of the left sclera. Treatment with methylprednisolone 80 mg intravenous infusion twice daily led to gradual symptom improvement and eventual resolution of inflammation. This report, based on a review of relevant literature, investigates the treatment and outcomes of zoledronic acid-induced scleritis, emphasizing the importance for clinicians to promptly identify and manage this rare and serious ocular adverse reaction.
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Affiliation(s)
- Dingling Ma
- Department of Endocrinology and MetabolismXiangtan Center HospitalXiangtanChina
| | - Can Xiao
- Department of Clinical PharmacyXiangtan Center HospitalXiangtanChina
| | - Deshui Zhao
- Department of Endocrinology and MetabolismXiangtan Center HospitalXiangtanChina
| | - Guohua Li
- Department of Endocrinology and MetabolismXiangtan Center HospitalXiangtanChina
| | - Wei Cheng
- Department of Endocrinology and MetabolismXiangtan Center HospitalXiangtanChina
| | - Xin Deng
- Department of Endocrinology and MetabolismXiangtan Center HospitalXiangtanChina
| | - Dan He
- Department of Endocrinology and MetabolismXiangtan Center HospitalXiangtanChina
| | - Kai Liu
- Department of OphthalmologyXiangtan Aier Renhe HospitalXiangtanChina
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Kanda P, Guerrero-Córdova I, Dhillon J, Tsang A. Case report: A severe case of zoledronate-associated diffuse orbital inflammation and uveitis in a patient with metastatic breast cancer. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1372429. [PMID: 38984119 PMCID: PMC11182180 DOI: 10.3389/fopht.2024.1372429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/25/2024] [Indexed: 07/11/2024]
Abstract
Introduction Zoledronate is a commonly prescribed medication to maintain bone health; however, a rare side effect includes ocular inflammation. We report a case of simultaneous anterior uveitis and orbital inflammation associated with zoledronate infusion in a patient with metastatic breast cancer. We also performed a literature search to provide an up-to-date summary of cases with zoledronate-associated ocular inflammation. Methods This is a case report with literature review. Literature search (timeline 2010 to 2023) was performed using PubMed with the search team: (zoledronate) AND (uveitis OR scleritis OR orbital inflammation OR ocular inflammation). Results A 48-year-old female presented with left eye pain, swelling, and decreased vision 2 days after receiving zoledronic acid infusion. An ophthalmic exam showed non-granulomatous anterior uveitis. CT orbits and ocular ultrasound showed signs of posterior scleritis and orbital inflammation. Ocular inflammation caused by an infection or metastatic cancer was ruled out. The patient was treated with both topical and systemic corticosteroids. Complete resolution of the inflammation occurred after 2.5 weeks. Conclusion Orbital inflammation and uveitis are an uncommon side effect of zoledronate but needs to be promptly recognized and treated to prevent sight-threatening complications.
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Affiliation(s)
- Pushpinder Kanda
- Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Adrian Tsang
- Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada
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Chacko G, Kota S, Kumar S, Ohri N, Omene C, Ganesan S, Toppmeyer DL, George MA. Uveitis, a rare but important complication of adjuvant zoledronic acid for early-stage breast cancer. Anticancer Drugs 2023; 34:592-594. [PMID: 36846985 DOI: 10.1097/cad.0000000000001503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Bisphosphonates such as zoledronic acid are an important part of adjuvant therapy to reduce the risk of recurrence in early-stage breast cancer. Uveitis remains one of the lesser-known side effects of zoledronic acid; prompt recognition is essential to ensure patients receive appropriate and timely care to help prevent permanent vision loss. We report a case of anterior uveitis in a postmenopausal woman who presented with visual symptoms after receiving the first dose of zoledronic acid. This case report serves to educate and increase awareness of the risk of uveitis in patients who are given zoledronic acid. This is the first and only reported case of zoledronic acid when used in the adjuvant setting for the treatment of breast cancer.
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Affiliation(s)
- Geena Chacko
- Rutgers Robert Wood Johnson Medical School, Department of Medicine
| | - Srigowri Kota
- Rutgers Cancer Institute of New Jersey, Department of Surgery
| | - Shicha Kumar
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology
| | - Nisha Ohri
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology
| | - Coral Omene
- Rutgers Cancer Institute of New Jersey, Department of Medicine, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Shridar Ganesan
- Rutgers Cancer Institute of New Jersey, Department of Medicine, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Deborah L Toppmeyer
- Rutgers Cancer Institute of New Jersey, Department of Medicine, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Mridula A George
- Rutgers Cancer Institute of New Jersey, Department of Medicine, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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Zheng J, Wang Y, Hu J. Study of the shared gene signatures of polyarticular juvenile idiopathic arthritis and autoimmune uveitis. Front Immunol 2023; 14:1048598. [PMID: 36969183 PMCID: PMC10030950 DOI: 10.3389/fimmu.2023.1048598] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectiveTo explore the shared gene signatures and potential molecular mechanisms of polyarticular juvenile idiopathic arthritis (pJIA) and autoimmune uveitis (AU).MethodThe microarray data of pJIA and AU from the Gene Expression Omnibus (GEO) database were downloaded and analyzed. The GEO2R tool was used to identify the shared differentially expressed genes (DEGs) and genes of extracellular proteins were identified among them. Then, weighted gene co-expression network analysis (WGCNA) was used to identify the shared immune-related genes (IRGs) related to pJIA and AU. Moreover, the shared transcription factors (TFs) and microRNAs (miRNAs) in pJIA and AU were acquired by comparing data from HumanTFDB, hTFtarget, GTRD, HMDD, and miRTarBase. Finally, Metascape and g: Profiler were used to carry out function enrichment analyses of previously identified gene sets.ResultsWe found 40 up-regulated and 15 down-regulated shared DEGs via GEO2R. Then 24 shared IRGs in positivity-related modules, and 18 shared IRGs in negatively-related modules were found after WGCNA. After that, 3 shared TFs (ARID1A, SMARCC2, SON) were screened. And the constructed TFs-shared DEGs network indicates a central role of ARID1A. Furthermore, hsa-miR-146 was found important in both diseases. The gene sets enrichment analyses suggested up-regulated shared DEGs, TFs targeted shared DEGs, and IRGs positivity-correlated with both diseases mainly enriched in neutrophil degranulation process, IL-4, IL-13, and cytokine signaling pathways. The IRGs negatively correlated with pJIA and AU mainly influence functions of the natural killer cell, cytotoxicity, and glomerular mesangial cell proliferation. The down-regulated shared DEGs and TFs targeted shared DEGs did not show particular functional enrichment.ConclusionOur study fully demonstrated the flexibility and complexity of the immune system disorders involved in pJIA and AU. Neutrophil degranulation may be considered the shared pathogenic mechanism, and the roles of ARID1A and MiR-146a are worthy of further in-depth study. Other than that, the importance of periodic inspection of kidney function is also noteworthy.
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Chartrand NA, Lau CK, Parsons MT, Handlon JJ, Ronquillo YC, Hoopes PC, Moshirfar M. Ocular Side Effects of Bisphosphonates: A Review of Literature. J Ocul Pharmacol Ther 2023; 39:3-16. [PMID: 36409537 DOI: 10.1089/jop.2022.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In rare cases, bisphosphonates are well established to cause ocular inflammation, presenting as uveitis, episcleritis, scleritis, orbital inflammation, and/or conjunctivitis. Some reports of bisphosphonate-associated neuro-ophthalmic complications also exist. We identified 101 reports in the literature relating to bisphosphonate-associated ocular complications. In a great majority of cases, symptoms resolve after discontinuation of the drug and anti-inflammatory treatment. Many cases recur if rechallenged with the same bisphosphonate. First-generation nonamino bisphosphonates, including clodronate and etidronate, are not associated with ocular inflammation. Only 2nd- and 3rd-generation amino bisphosphonates, including pamidronate, alendronate, risedronate, ibandronate, and zoledronate are associated with these complications. The mechanism of bisphosphonate-induced ocular inflammation may be related to activation of γ/δ T cells or M1 macrophages. Intravenous forms, such as pamidronate and zoledronate, tend to have higher rates and faster onset of ocular inflammation, generally presenting within days of infusion. In oral bisphosphonates, such as alendronate and risedronate, these complications present with more sporadic timing. Rates of complications are also higher when bisphosphonates are used for malignancy, as doses tend to be higher compared with doses for osteoporosis.
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Affiliation(s)
| | - Chap-Kay Lau
- College of Medicine Phoenix, University of Arizona, Phoenix, Arizona, USA
| | - Mark T Parsons
- College of Medicine Phoenix, University of Arizona, Phoenix, Arizona, USA
| | | | | | | | - Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, Utah, USA.,Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Utah Lions Eye Bank, Murray, Utah, USA
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Efectos adversos oculares relacionados con la administración de bifosfonatos parenterales: experiencia del médico de familia. Semergen 2022; 48:101826. [DOI: 10.1016/j.semerg.2022.101826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/05/2022] [Accepted: 07/04/2022] [Indexed: 11/21/2022]
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