Case Report Intravenous Laser Blood Irradiation and Tocilizumab in a Patient with Juvenile Arthritis Dragos Andrei Chiran, 1 Michael Weber, 2 Laura Marinela Ailioaie, 3,4 Eovelina Moraru, 1,5 Constantin Ailioaie, 1,4,5 Daniela Litscher, 6 and Gerhard Litscher 6 1 Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania 2 Institute for Laser Terapy and Acupuncture, Sohnreystraße 6, 37697 Lauenf¨ orde, Germany 3 Department of Medical Physics, “Alexandru Ioan Cuza” University, 11 Carol I Boulevard, 700506 Iasi, Romania 4 Laser Clinic, 83 Arcu Street, 700135 Iasi, Romania 5 Second Pediatric Clinic, Street Mary Emergency Hospital for Children, 62 Vasile Lupu St., 700309 Iasi, Romania 6 Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine and TCM Research Center Graz, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria Correspondence should be addressed to Gerhard Litscher; gerhard.litscher@medunigraz.at Received 26 December 2013; Accepted 27 January 2014; Published 4 March 2014 Academic Editor: Larry W. Moreland Copyright © 2014 Dragos Andrei Chiran et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tis study presents efects of intravenous laser blood irradiation (ILBI) in a transient immunodefciency patient with juvenile idiopathic arthritis (JIA) treated with an interleukin-6 receptor inhibitor (Tocilizumab). Biological agents induce JIA remission, but some patients do not respond favorably to this fnal therapeutic line of defense. ILBI was performed in a 16-year-old male patient, with JIA and transient immunodefciency. When ILBI was introduced, the patient was receiving disease-modifying drugs, steroids, tocilizumab, and physical therapy. Because the disease was not well controlled, ILBI was applied in addition to other ongoing therapies. Te patient underwent 1 session daily, and 10 successive sessions per month, repeated every 3 months, for 7 months. Patient evaluation was performed before ILBI was started and at 3, 6, 9, and 12 months afer ILBI initiation, using the ACR Pediatric response. Te outcome was evaluated using Pediatric 50, 70, and 90 responses and compared to initial status, afer 3, 6, 9, and 12 months. At the end of study, the titre of IgA and IgG levels returned to normal. Synergistic anti-infammatory efect of ILBI was evident, if applied additionally in combination with tocilizumab, in a patient with a therapy-resistant severe form of JIA and related subacute transient immunodefciency. 1. Introduction Juvenile idiopathic arthritis (JIA) is an infammatory disorder of the connective tissues, characterized by joint swelling, pain, and tenderness. Overproduction of tumor necrosis factor alpha (TNF-), interleukin-6 (IL-6), and interleukin- 1 beta (IL-1) is a well-known fact in JIA. Increased levels of these cytokines, both in serum and synovial fuid, induce the production of vascular endothelial factor, triggering angiogenesis in the afected joint. IL-6 is also considered responsible for osteoclast diferentiation, followed by joint destruction and osteoporosis [1]. In the last decade, the development of biological agents that target these key infammatory cytokines or their recep- tors brought new horizons in JIA treatment. Disease remis- sion became a reachable goal [2]. However, few patients develop a severe chronic rheumatic type of the disease [3]. TNF- inhibitors are the frst-line biological agents used in JIA, if therapy with anti-infammatory and disease-modifying antirheumatic drugs (DMARDs) proved to be inefcient. IL-6 receptor inhibition with Tocilizumab is a new second- line therapy for anti-TNF- nonresponding patients, based on the blockade of IL-6-regulated signaling pathways [1, 2]. Hindawi Publishing Corporation Case Reports in Medicine Volume 2014, Article ID 923496, 6 pages http://dx.doi.org/10.1155/2014/923496