Drugs that antagonize cytokines (IL-6, TNF-α, IL-1β) including tocilizumab, adalimumab, anakinra, and canakinumab have all been administered off-label to ROSAH patients with reports of varying levels of efficacy3,15–17. Here, IL6 is linked to retinal dystrophy, optic nerve edema, splenomegaly, anhidrosis, and migraine headache syndrome.