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అందరికి ప్రవేశం

నైరూప్య

Occult Giant Cell Arteritis Responding Promptly to Tocilizumab after Failure of High Dose Corticosteroid Therapy

Hamam R, EI Halabi T, Ramia M, EI Halabi M, Merashli M

A 72 year old lady, who presented with blurry vision in both eyes, was diagnosed based on ophthalmological exam as having occult Giant Cell Arteritis (GCA) without any systemic symptoms despite the fact that she did not respond initially to intravenous steroids. Patient was directly switched to Tocilizumab to notice marked improvement in her symptoms afterwards. Interleukin-6 has been shown to be a key cytokine in GCA, and that explains why Tocilizumab, a humanized monoclonal antibody targeting interleukin- 6 receptor, was FDA approved for the treatment of GCA. However, encountering a patient with occult GCA, having almost complete blindness, responding acutely to Tocilizumab after failing initial high dose steroid therapy, such as in the present case, was not reported before. In addition, the marked improvement in the symptoms, along with the patient being able to avoid long term steroid side effects, raises the subject of whether Tocilizumab should be attempted promptly in patients with steroid resistant occult GCA.