Ten-year Perplexing Panuveitis Course in a Case with Juvenile Idiopathic Arthritis and a History of Tuberculosis
Journal
Ocular Immunology and Inflammation
Journal Volume
24
Journal Issue
1
Pages
99-102
Date Issued
2016
Author(s)
Hsu, Yung-Ray
Abstract
The differentiation of infectious and noninfectious etiologies of uveitis has always been a major concern for uveitis specialists. In patients with previous systemic infection with tuberculosis (TB) and a concurrent history of noninfectious uveitic entities, a definite diagnosis can sometimes be rather elusive. Here, we report a 10-year perplexing course of panuveitis in a patient with juvenile idiopathic arthritis (JIA) and a history of TB. A 20-year-old woman presented with an insidious onset painless chronic iritis for 6 months in both eyes (BE) treated elsewhere in 2000. Nongranulomatous keratic precipitates, posterior synechiae, and secondary glaucoma, complicated by cataracts with blurred fundi, were noted. Visual acuity (VA) was 20/100 (BE). She had been diagnosed with pauciarticular JIA by a pediatric rheumatologist at the age of 15 years, with an unremarkable result of ophthalmic screening at diagnosis only once. Pulmonary and spinal TB was noted when she was 18 years old, for which she received 12 months of complete treatment. No ocular symptoms were noted during that hospitalization. JIA-related iritis was first suspected. Trabeculectomy with peripheral iridectomy done in 2000 (right eye, RE) allowed much improved pressure control. Meanwhile, systemic methotrexate and a topical steroid were administered. Only intermittent low-grade anterior chamber reaction (BE) was noted in the following 3 years. However, lens capsule rupture was noted in 2003, with aggravated iritis (RE). Cataract extraction without intraocular lens (IOL) implantation was initially attempted. However, upon the patient’s request to avoid a secondary operation, simultaneous in-the-bag IOL implantation was done (RE). Postoperative inflammation control was satisfactory with an intensive topical steroid, a systemic steroid 0.5 mg/kg, and methotrexate. Six months later, cataract surgery with IOL implantation was done on the left eye (LE) with preoperatively silent anterior chamber, with the same strategy of perioperative medications. Systemic
SDGs
Other Subjects
isoniazid; methotrexate; pyrazinamide; rifampicin; steroid; tuberculostatic agent; antirheumatic agent; methotrexate; adult; anterior eye chamber; case report; cataract extraction; disease association; disease course; female; human; iritis; juvenile rheumatoid arthritis; lens implant; Letter; lung tuberculosis; medical history; tuberculosis; tuberculous spondylitis; uveitis; visual acuity; young adult; Arthritis, Juvenile; combination drug therapy; complication; fluorescence angiography; Panuveitis; tuberculin test; Tuberculosis, Ocular; Tuberculosis, Pulmonary; Tuberculosis, Spinal; Adult; Antirheumatic Agents; Antitubercular Agents; Arthritis, Juvenile; Drug Therapy, Combination; Female; Fluorescein Angiography; Humans; Methotrexate; Panuveitis; Tuberculin Test; Tuberculosis, Ocular; Tuberculosis, Pulmonary; Tuberculosis, Spinal
Type
journal article