{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:15:13Z","timestamp":1792800913211,"version":"4.5.0"},"reference-count":17,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,14]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>We report the first known case of uveitis and keratitis caused by zanubrutinib, a second-generation Bruton tyrosine kinase (BTK) inhibitor in a patient with Waldenstr\u00f6m macroglobulinaemia (WM). The patient was a man in his early 50s who had WM, a type of non-Hodgkin's lymphoma which produces monoclonal IgM. He developed posterior uveitis, characterised by vitreous and retinal infiltrates, while taking 280 mg of oral ibrutinib, the targeted therapy for WM. This is a known, rare adverse event of first-generation BTK inhibitors such as ibrutinib. The inflammation resolved spontaneously after discontinuing ibrutinib, without steroid intervention. Causality was confirmed when the uveitis and infiltrates promptly recurred on re-challenge with oral ibrutinib at a half-dose of 140 mg. A subsequent switch to the oral second-generation BTK inhibitor zanubrutinib resulted in an immediate, severe panuveitis with keratitis, which resolved on discontinuation of the drug. This definitive challenge\u2013de-challenge\u2013re-challenge sequence provides compelling evidence for a potential class effect of BTK inhibitors and ocular inflammation. Clinicians should be vigilant in monitoring for ocular symptoms in those taking zanubrutinib, especially if they have experienced sensitivity to other BTK inhibitors.<\/jats:p>","DOI":"10.1136\/bcr-2026-272742","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:33:14Z","timestamp":1790692394000},"page":"e272742","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Uveitis as a class effect of Bruton tyrosine kinase inhibitors: ibrutinib and zanubrutinib ocular toxicity"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5033-7942","authenticated-orcid":false,"given":"Oliver","family":"Beresford","sequence":"first","affiliation":[{"name":"Cardiff University School of Medicine, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0479-2204","authenticated-orcid":false,"given":"Ze Yan","family":"Ooi","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hospital Sultan Abdul Halim, Sungai Petani, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayad","family":"Al-Bermani","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital of Wales, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"2026092907202278000_19.9.e272742.1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.18036"},{"key":"2026092907202278000_19.9.e272742.2","doi-asserted-by":"publisher","DOI":"10.1053\/sonc.2003.50069"},{"key":"2026092907202278000_19.9.e272742.3","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2015-01-553974"},{"key":"2026092907202278000_19.9.e272742.4","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2020.01712","article-title":"Trends in Incidence and Mortality of Waldenstr\u00f6m 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Meta-Analysis","volume":"140","author":"Wang","year":"2022","journal-title":"Blood"},{"key":"2026092907202278000_19.9.e272742.9","doi-asserted-by":"crossref","first-page":"NP94","DOI":"10.1177\/11206721211001268","article-title":"Ibrutinib-related uveitis: A report of two severe cases","volume":"32","author":"Bohn","year":"2022","journal-title":"Eur J Ophthalmol"},{"key":"2026092907202278000_19.9.e272742.10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1200710"},{"key":"2026092907202278000_19.9.e272742.11","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1981.154"},{"key":"2026092907202278000_19.9.e272742.12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1400376"},{"key":"2026092907202278000_19.9.e272742.13","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2024.1413985","article-title":"Efficacy and safety of first- versus second-generation Bruton tyrosine kinase inhibitors in chronic lymphocytic leukemia: a systematic review and 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