BILATERAL PANUVEITIS IN AN ELDERLY WOMAN Dra MC

BILATERAL PANUVEITIS IN AN ELDERLY WOMAN Dra. MC, ALVARADO VALERO, Dra. MT PEDRAZ PENALVA, Dr. JC ELVIRA CRUAÑES. HOSPITAL UNIVERSITARIO DEL VINALOPO

BILATERAL PANUVEITIS IN AN ELDERLY WOMAN - A 84 years old woman was submitted to our ophthalmology department because of progressive two-sided visual loss. - Moreover, the patient was been evaluated at the pneumology department because of weightloss and fatigue and the recent finding of hilar lymphadenopathies and mediastinal mass. - To highlight: Chronic Hepatitis C infection.

BILATERAL PANUVEITIS IN AN ELDERLY WOMAN - 84 years old woman - progressive two-sided visual loss - weightloss and fatigue - hilar lymphadenopathies - mediastinal mass - Chronic Hepatitis C infection OCULAR EXAMINATION 1. VISUAL ACUITY : 20/40 OU 2. SLIT LAMP BIOMICROSCOPY : 1. 3. Anterior bilateral granulomatous uveitis FUNDUS EXAMINATION 2. Moderate vitritis. 3. Bilateral disk edema 4. Bilateral cystoid macular edema (OCT). 5. Haemorrhagic retinopathy

BILATERAL PANUVEITIS IN AN ELDERLY WOMAN. Bilateral papilitis

BILATERAL PANUVEITIS. Fluorescein angiography

BILATERAL PANUVEITIS IN AN ELDERLY WOMAN. Differential diagnosis � PRIMARY INTRAOCULAR LYMPHOMA � INFECTIONS � TUBERCULOSIS, SYPHILIS, LYME DISEASE , HIV � SARCOIDOSIS

DIFFERENTIAL DIAGNOSIS……………. PRIMARY INTRAOCULAR LYMPHOMA 1. MRI (brain and orbits): It was negative for malignancy 2. Chest x-ray: Hilar lymphadenopathies 3. CT : 1. 2. 3. 4. thymic or pleuropericardial cyst Hilar and paratracheal lymphadenopathies Interstitial lung pattern Vitreous biopsy: was read as negative for malignancy. ( No monoclonal CD 20 , 19 y 45 LB, IL 10/1 L 6 no >3, 2). Were only observed monocytes and LT TBC, SYPHILIS, LYME DISEASE. . 1. TB-screening: Mantoux negative, Quantyferon-TB negative. 2. Syphilis Serology ( treponemic and no treponemic test). 1. Borrelia burgdorferi serology negative. 2. Serology HIV negative

BILATERAL PANUVEITIS IN AN ELDERLY WOMAN… DIAGNOSTIC TESTS: “VERY LIKELY SARCOIDOSIS” • LABORATORY TESTING: high ACE levels 162 IU/L (13 -63, 9) • CT: Bilateral hilar lymphadenopathy and intersticial lung pattern. • FIBEROPTIC BRONCHOSCOPY • BAL (bronchoalveolar lavage): ratio CD 4 / CD 8 = 12 • BB (Transbronchial biopsy) • PTB ( paratracheal biopsy): • Inconclusive results for BB and PTB. • Staining Ziehl-Neelsen negative

… “VERY LIKELY SARCOIDOSIS”. TREATMENT…. � 1) Topical treatment for granulomatous uveitis… � 2) Intravitreal dexamethasone injection � 3) Prednisone oral 1 mg/kg/day for 10 days. . And thereafter, slow tapering and large- treatment with low prednisone dosis. . ( < 10 mg /day). � 4) Methotrexate ( stopped bacause of increase of liver enzymes in this patient with chronic hepatitis C infection) � 5) Mycophenolate mofetil

PANUVEITIS IN AN ELDERLY WOMAN: …. . FOLLOW-UP