Case report: A severe case of zoledronate-associated diffuse orbital inflammation and uveitis in a patient with metastatic breast cancer

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.

[Uveitis: RESULTS of a prospective randomized clinical and immunological study]

AIM

to evaluate the RESULTS of a randomized prospective clinical and immunological study conducted during 2012-2014 in patients with uveitis.

MATERIAL AND METHODS

The main group consisted of 200 randomly selected patients with uveitis including 114 men (57%) and 86 women (42%) aged 19-57 years. A comprehensive ophthalmic and immunological examination was performed in all patients regardless of them having a relapse or remission. To assess patient's immune status, we investigated parameters of cellular and humoral immunity as well as complement components C3 and C4 levels.

RESULTS

Systemic connective tissue disorders appeared to be the main cause of uveitis among the patients examined - 32% of cases. But if to consider distinct nosological entities, first place goes to herpes virus infection - 22% of cases. In general, infectious uveitis was diagnosed in 43.5% of cases, underlying systemic conditions were found in other 46%, and finally, in some patients, uveitis was identified as posttraumatic (4.5%) or idiopathic (6%). A total of 60.5% of patients showed clinical and functional improvement under treatment. Irreversible blindness in 9 patients was due to one of the following: secondary glaucoma (4 cases, 2%), retinal detachment (3 cases, 1.5%), or ocular subatrophy (2 cases, 1%). Late referral (i.e. after the development of irreversible secondary complications) should be named as one of the main causes of low vision in patients with uveitis. As to laboratory changes, only those in cellular and congenital immunity factors were statistically significant.

CONCLUSION

In order to minimize the risk of proliferative secondary complications, a tool should be created such as a single database of uveitis patients, according to which they could be followed up. Long-term immunosuppressive therapy for uveitis may lead to herpesvirus reactivation. The complex nature of immune disorders justifies certain corrective measures in uvetis patients but only with account to their current immune status.