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Title	Three cases of induction of scleritis as a paradoxical reaction to TNF inhibitor and CTLA4Ig
Accept poster if oral is not possible ?	Yes

Purpose	Multiple paradoxical reactions to biological agents have been identified including ocular disease.
Methods	We report three cases of scleritis induced by a tumor necrosis factor(TNF) inhibitor and cytotoxic T-lymphocyte antigen 4(CTLA4Ig).
Results	A 64-year-old female patient had been receiving abatacept for rheumatoid arthritis. After 3 months, she developed diffuse scleritis with peripheral corneal infiltration, dacryoadenitis, blepharitis, and secondary glaucoma. Topical steroids were administered, and the symptoms resolved. She continues to receive abatacept. A 76-year-old female patient developed pneumocystis pneumonia associated with abatacept. Abatacept was suspended for 18 months, and she developed diffuse scleritis. Abatacept was re-administered, but the scleritis worsened and was accompanied by macular edema. The biologic was switched from abatacept to golimumab, after which her scleritis and macular edema resolved completely. A 44-year-old female patient had been receiving etanercept for rheumatoid arthritis. After 1 year, she developed diffuse scleritis. The biologic was switched from etanercept to tocilizumab, and her scleritis resolved immediately.
Conclusion	Scleritis as a paradoxical reaction can be induced by some types of biological agents. We reported three cases of scleritis presumably induced by the biologic. Scleritis resolved following administration of steroid therapy or switching the biologic.
Conflict of interest	No

Author 1

Last name	TAKEDA
Initials of first name(s)	A
Department	Nippon Medical School Tama-nagayama Hospital Ophthalmology
City	Tokyo
Country	Japan

Author 2

Last name	Yui
Initials of first name(s)	S
Department	Nippon Medical School Hospital Ophthalmology
City	Tokyo
Country	Japan

Author 3

Last name	Ogura
Initials of first name(s)	E
Department	Nippon Medical School Hospital Ophthalmology
City	Tokyo
Country	Japan

Author 4

Last name	Hori
Initials of first name(s)	J
Department	Nippon Medical School Tama-nagayama Hospital Ophthalmology
City	Tokyo
Country	Japan