Zoledronic acid
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Zoledronic acid Orbital inflammatory disease: case report A 57-year-old woman developed orbital inflammatory disease during treatment with zoledronic acid for postmenopausal osteoporosis. The woman, whose history included oesophageal cancer with gastric pull-up, breast cancer and lung cancer (all in remission) had been receiving IV ibandronic acid every 3 months (a total of six infusions). She was switched to IV zoledronic acid because of its yearly dosing schedule and, several hours after her initial IV infusion of zoledronic acid [dosage not stated], she developed a painful, swollen left eye with photophobia. On ophthalmologic examination, grade 3+ oedema of her left upper eyelid was observed. Slit lamp examination revealed grade 2–3+ conjunctival injection in the left eye with elevated intraocular pressure of 45mm Hg (right eye intraocular pressure was 18mm Hg). An orbital CT scan demonstrated inflammation of the left orbital, retroseptal and preseptal spaces, along with globe wall thickening. A diagnosis of orbital inflammatory disease was made. The woman received prednisone and azithromycin. Her periorbital oedema subsided although she had residual photophobia and pain. On the ninth day following the initial episode, methylprednisolone dose packs were initiated and her left eye oedema and erythema resolved completely over the following 2 weeks. For the next 9 months, she remained symptom-free. On subsequent questioning, she recalled the development of mild left eye oedema after two of the six ibandronic acid infusions which she had attributed to insect bites and had not reported. Author comment: "The mechanism by which bisphosphonates cause ocular and orbital inflammation remains unknown, but may be due to the release of cytokines such as interleukin-1 and interleukin-6 along with other acute-phase reactants that bisphosphonates are known to trigger." Kaur H, et al. Orbital inflammatory disease in a patient treated with zoledronate. Endocrine Practice 17: e101-e103, No. 4, Aug 2011. Available from: URL: http:// 803060990 dx.doi.org/10.4158/ep11081.cr - USA
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Reactions 8 Oct 2011 No. 1372
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