Sepsis During Immunosuppression for Sight-threatening Uveitis: The Flip side.

PURPOSE: To highlight the rare but life-threatening infective consequences of immunosuppression or biologic treatment for sight-threatening uveitis.

PATIENTS AND METHODS: Retrospective case series of four immunosuppressed patients with uveitis complicated by sepsis.

RESULTS: The affected patients were all treated using prednisolone 10 mg/day or greater, together with oral immunosuppression (2 mycophenolate mofetil, 1 azathioprine + ciclosporin, 1 methotrexate) and, in one case, infliximab. All patients survived following intensive treatment.

CONCLUSION: Life-threatening infection is a rare but important risk in immunosuppressed patients with uveitis. Complete protection is not possible and prophylaxis regimens are of unproven efficacy. Patients should understand the risks before agreeing to a course of treatment.