Tolicizumab effectively controls giant cell arteritis and prevents recurrence of steroid-induced concomitant toxoplasmosis chorioretinitis.

Abstract

Giant cell arteritis (GCA) affects various ocular structures and potentially leads to vision loss. Traditional therapy involves a tapering regimen of high-dose systemic corticosteroids which are associated with adverse effects, including the risk of opportunistic infections such as toxoplasmosis from immune suppression. Tocilizumab, a humanised monoclonal antibody directed against the interleukin-6 receptor, offers an effective treatment option for GCA. In this report, we detail the successful treatment of GCA-associated, steroid-induced recurrent toxoplasma chorioretinitis (RTRC) using intravenous tocilizumab. A female patient in her 70s presented with GCA treatment challenges with prednisone, and subsequent complications of RTRC are discussed. 12 months after the initial presentation, the patient was treated with intravenous tocilizumab, leading to rapid resolution of the active lesion. At the 1-year follow-up, the patient maintained 20/20 vision and showed no signs of inflammation or toxoplasmosis reactivation. This case suggests tocilizumab may be an effective alternative treatment for managing GCA, particularly in cases complicated by RTRC.