Uveitis in a patient treated with Bacille-Calmette-Guérin: possible antigenic mimicry of mycobacterial and retinal antigens.

Abstract

PURPOSE:

To investigate the cellular immune response in uveitis developing after intravesical Bacille-Calmette-Guérin (BCG) applications.

DESIGN:

Experimental study.

PARTICIPANTS:

A 72-year-old HLA-B27-negative patient with bilateral granulomatous anterior uveitis that developed during the third cycle of intravesical BCG applications she was receiving for treatment of bladder carcinoma.

METHODS:

The patient's peripheral T cell reactivity to ocular autoantigens was compared with the response to purified protein derivative (PPD) from Mycobacterium tuberculosis. T-cell proliferation and cytokine and chemokine secretion were measured in vitro.

MAIN OUTCOME MEASURES:

Anterior uveitis was treated successfully with topical corticosteroids and cycloplegics.

RESULTS:

The following were demonstrated: proliferation to PPD, interphotoreceptor retinoid-binding protein (IRBP), and IRBP-peptide R16, as well as secretion of proinflammatory cytokines in response to PPD, retinal soluble antigen (S-Ag), IRBP, cellular retinal-binding protein (CRALBP), and some S-Ag and IRBP peptides.

CONCLUSIONS:

These data indicate the generation of a polyclonal autoimmune reaction elicited by BCG. Amino acid sequence alignments revealed homologies between proteins from M. tuberculosis, BCG, and retinal antigens, suggesting antigenic mimicry as a potential cause of uveitis in this patient.

• Authors: Aylin Garip, Maria Diedrichs-Möhring, Stephan R Thurau, Cornelia A Deeg, Gerhild Wildner
• Journal: Ophthalmology (Ophthalmology) Vol. 116 Issue 12 Pg. 2457-62.e1-2 (Dec 2009) ISSN: 1549-4713 [Electronic] United States
• PMID: 19815288 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antigens, Bacterial
• Autoantigens
• BCG Vaccine
• Cytokines
• Glucocorticoids
• HLA-B27 Antigen
• Mydriatics

Topics

• Aged
• Amino Acid Sequence
• Antigens, Bacterial (immunology)
• Autoantigens (immunology)
• BCG Vaccine (adverse effects, immunology)
• Cytokines (metabolism)
• Female
• Glucocorticoids (therapeutic use)
• HLA-B27 Antigen (immunology)
• Humans
• Immunity, Cellular
• Immunotherapy
• Lymphocyte Activation (drug effects)
• Molecular Mimicry (immunology)
• Molecular Sequence Data
• Mycobacterium (immunology)
• Mydriatics (therapeutic use)
• Retina (immunology)
• Sequence Homology, Amino Acid
• T-Lymphocytes (immunology)
• Urinary Bladder Neoplasms (drug therapy)
• Uveitis, Anterior (drug therapy, etiology, immunology)