Okkulte Proteinverlustenteropathie als Ursache der Therapieresistenz einer nichtinfektiösen Uveitis – Fallbericht

A 17-year-old boy with a Fontan circulation developed treatment refractory bilateral noninfectious uveitis at the age of 15 years. Despite intensive local and systemic treatment, including the use of the monoclonal antibody adalimumab and methotrexate, the symptoms continued. In the absence of peripheral edema or effusions and with hypoalbuminemia, hypogammaglobulinemia and severe lymphopenia, an “occult” protein-losing enteropathy (PLE) was diagnosed. It is highly likely that the partial loss of adalimumab due to PLE led to secondary treatment failure. This case emphasizes the importance of considering PLE in cases of treatment refractory autoimmune diseases and the previously named laboratory parameter constellation, which can also occur in noncardiological primary diseases.