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Anterior bilateral acute uveitis: seeing the general picture

Poster Details

First Author: M. Srur Colombo SPAIN

Co Author(s):    J. Fajardo Sanchez   C. Chau Ramos   P. Mazagatos Used   R. Yela   F. Alcantud Jimenez   D. Da Saude

Abstract Details

Purpose:

To evaluate and describe the clinical presentation of anterior bilateral acute uveitis as a sign of a systemic disease.

Setting:

We present the description and retrospective analisis of a patient with Tubulointerstitial Nephritis and Uveitis (TINU) syndrome that was diagnosed due to the appearence of a very specific type of uveitis.

Methods:

Ophthalmologic and Intern Medicine evaluation. Literature’s review. 52 year old woman is admitted in the Emergency Room because of the following signs: redness of the eye, photophobia, eye pain and Visual Acuity (VA) reduced, all of these in both eyes (BE). She refers that 2 months ago these ocular signs appeared for the first time while she started using daily NSAID’s for an sprained ankle. These appeared again in the following weeks and she treated it as an infectious conjunctivitis. In her medical history we found anemia, pollakiuria, episodes of fever and weight loss since 6 weeks ago.

Results:

Best VA of BE: 0.6. At the slit–lamp biomicroscopy of BE: Ciliary flush, keratic precipitates nongranulomatous, Tyndall +++ and posterior synechiae. The rest was normal. The diagnosis was Anterior Bilateral nongranulomatous Acute Uveitis. We treated it with cycloplegic and topical corticosteroids and order a blood and urine test. It was positive to: hypochromic microcytic anemia, high ESR, high BUN, proteinuria, glycosuria and leukocyturia. With these results, she was diagnosed of Acute Kidney Failure. In the following weeks, the uveitis came back several times and the kidney’s function got worse. A kidney biopsy was made: it showed a Tubulointerstitial Nephritis.

Conclusions:

We made a clinical review of all the signs and tests, and the final diagnosis was: Anterior Bilateral nongranulomatous Acute Uveitis in a patient with TINU syndrome. In many cases, Uveitis can be the first part of a systemic disease; showing us just the tip of the iceberg. To make a correct and precise diagnosis we should see and evaluate uveitis as a sign of a possible occult pathology. TINU syndrome is an infrequent presentation of bilateral acute uveitis to have in mind when it shows in an ophthalmology practice. FINANCIAL DISCLOUSRE: NONE

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