8476 Case of Zoledronic Acid Induced Acute Anterior Uveitis In A 63-Year-Old Woman

Abstract Disclosure: R. Halstrom: None. J. Sanchez Perez: None. A. Lobo-Chan: None. S. Reutrakul: None. Background: Bisphosphonates used for osteoporosis treatment are commonly known for their adverse gastrointestinal side effects and jaw osteonecrosis. Here, we document a case of anterior uveitis and scleritis post intravenous zoledronic acid infusion. Clinical case: A 63-year-old woman with osteoporosis, Graves disease complicated by thyroid eye disease s/p thyroidectomy, gastroesophageal reflux disease, positive antinuclear antibody and cataracts presented for a follow up of osteoporosis. She previously took alendronate 70 mg weekly for four years given a multi-bone arm fracture after a fall from standing height. On follow up 2 years after treatment, bone mineral density (BMD) by dual-energy absorptiometry had improved in the right femoral neck (T score from -3.3 to -1.8). A repeat BMD while on drug holiday showed T-score at left femoral neck of -2.4, with a calculated fracture risk assessment tool (FRAX) score of 18% and 4.8% for major and hip osteoporotic fractures, respectively. A zoledronic acid infusion was given due to elevated FRAX score, fracture history, and severe acid reflux. Nine days post-infusion, she presented to the emergency room with 2 days of right eye pain with blurry vision, eyelid swelling, photophobia, and tearing. Physical examination showed conjunctival and scleral injection, punctate epithelial erosions on corneal staining, and anterior chamber with anterior chamber cell. Labs were notable for weak positive RNP 29 (<19u). The following autoantibodies and levels were within normal limits: TSH 2.08 (0.35-4.0 mciu/ml), freeT4 1.0 (0.6-1.7 ng/dl), C3 152 (90-180 mg/dl), C4 33 (12-47 mg/dl), ESR 9 (<20 mm/hr), CRP 7 (<19u), SSA 0 (<29AU/ml), SSB 0 (<29AU/ml), dsDNA 4 (<24IU), Rh Factor (<10IU/ml), CCP 7 (<19U), and ANA. The patient was started on prednisolone acetate 1% 4 times daily, cyclopentolate twice daily with naproxen added 3 days later for additional anti-inflammatory treatment for the mild scleritis component. Therapy led to significant improvement on follow up 3 weeks later and topical corticosteroids and oral NSAIDs were tapered and discontinued. Conclusion: The onset of ocular symptoms and negative inflammatory workup raised concern for bisphosphonate induced anterior uveitis and scleritis. This case displays a rare side effect of bisphosphonate induced ocular inflammation with an approximate incidence of 0.046%-1% (1). We present this case in a patient with autoimmune disease and prior tolerance to oral bisphosphonate to shed light on a lesser-known side effect of bisphosphonates to promote prompt recognition and treatment. Reference: (1) Chartrand, Nicholas A., et al. “Ocular Side Effects of Bisphosphonates: A Review of Literature.” Journal of Ocular Pharmacology and Therapeutics, 39;1;2023, 3-16. Presentation: 6/3/2024