Paradoxical Exacerbation of Birdshot Retinochoroiditis Following Rituximab.

PURPOSE: We report a case of exacerbated ocular inflammation following rituximab treatment in a patient with Birdshot Retinochoroiditis.

METHOD: Retrospective single case report.

RESULT: Following rituximab administration for Birdshot Retinochoroiditis, the patient developed bilateral increase in choroidal thickness with retinal pigment epithelium undulations and subretinal fluid on enhanced depth imaging optical coherence tomography (EDI-OCT). Indocyanine green angiography (ICGA) demonstrated bilateral fuzzy and obscured choroidal vessels with diffuse late hyperfluorescence. Electroretinography (ERG) showed delayed amplitudes, indicating retinal dysfunction. The patient was rescued with intravenous methylprednisolone, followed by high-dose oral steroids. Rituximab was discontinued, and abatacept was initiated.

CONCLUSION

This case highlights a potential paradoxical exacerbation of intraocular inflammation following rituximab in Birdshot Retinochoroiditis, an observation already reported in other areas but rarely seen in ophthalmology.