To the Editor:
Tocilizumab is a humanized IgG1 anti-interleukin 6 (anti-IL-6) receptor monoclonal antibody that inhibits both soluble and membrane-expressed IL-6 receptors, limiting multiple proinflammatory IL-6 activities through inhibition of the gp130 receptor pathway. Tocilizumab showed clinical efficacy in rheumatoid arthritis (RA) when used in monotherapy or with disease-modifying antirheumatic drugs.
We describe the first case of ophthalmic herpes zoster (HZ) in a patient with RA who was treated with tocilizumab.
The patient was a 64-year-old woman with seropositive erosive RA, successively treated with hydroxychloroquine, methotrexate (MTX), leflunomide, then with biologic therapies etanercept and adalimumab, without lasting efficacy. Tocilizumab (8 mg/kg IV/week) associated with MTX (10 mg/week) was then given, with good clinical and biological efficacy, without the need for steroids. After 9 months of tocilizumab treatment, she developed HZ duplex bilateralis, combining a right ophthalmic HZ (vesicles on the tip, side, and root of the nose) and a C4 metamere HZ with painful grouped erythematous vesicles at …
Address correspondence to Dr. C. Roux, Hopital l’Archet 1, Route de Saint Antoine de Ginestiere, 06100 Nice, France. E-mail: roux101fr{at}yahoo.fr