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A Boy With Anterior Uveitis and Optic Disc Swelling

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A 14-year-old boy was referred to us because of ocular and periocular pain with photophobia in his right eye for the last 5 days. Aside from atopic dermatitis, his medical history was unremarkable. Best-corrected visual acuity was 20/20 OU. Slitlamp examination of the right eye disclosed conjunctival hyperemia and ciliary congestion, anterior chamber flare 2+, and a few nongranulomatous keratic precipitates; the left anterior segment was quiet. Intraocular pressure was 15 mm Hg OU. Pupillary light responses were normal. Dilated fundus examination revealed 1+ of vitritis (binocular indirect ophthalmoscopy score) in the right eye and swelling of the optic disc in both eyes, to a greater extent in the right eye (Figure, A). Routine blood tests, including full blood cell count, plasma glucose levels, liver function test, and kidney function test, were performed on the same day and showed a serum creatinine level of 1.57 mg/dL (reference range: 0.5-1.0 mg/dL; to convert to micromoles per liter, multiply by 88.4). Antibodies anti–Treponema pallidum were tested and the results were negative.

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A 14-year-old boy was referred to us because of ocular and periocular pain with photophobia in his right eye for the last 5 days. Aside from atopic dermatitis, his medical history was unremarkable. Best-corrected visual acuity was 20/20 OU. Slitlamp examination of the right eye disclosed conjunctival hyperemia and ciliary congestion, anterior chamber flare 2+, and a few nongranulomatous keratic precipitates; the left anterior segment was quiet. Intraocular pressure was 15 mm Hg OU. Pupillary light responses were normal. Dilated fundus examination revealed 1+ of vitritis (binocular indirect ophthalmoscopy score) in the right eye and swelling of the optic disc in both eyes, to a greater extent in the right eye (Figure, A). Routine blood tests, including full blood cell count, plasma glucose levels, liver function test, and kidney function test, were performed on the same day and showed a serum creatinine level of 1.57 mg/dL (reference range: 0.5-1.0 mg/dL; to convert to micromoles per liter, multiply by 88.4). Antibodies anti–Treponema pallidum were tested and the results were negative.

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Article Information

Corresponding Author: Giuseppe Casalino, MD, Oftalmico Hospital, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde n.3, 20121 Milan, Italy (peppecasalino@gmail.com).

Published Online: September 23, 2021. doi:10.1001/jamaophthalmol.2021.1056

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient’s parent for granting permission to publish this information.

References
1.
Hettinga  YM , Scheerlinck  LME , Lilien  MR , Rothova  A , de Boer  JH .  The value of measuring urinary β2-microglobulin and serum creatinine for detecting tubulointerstitial nephritis and uveitis syndrome in young patients with uveitis.   JAMA Ophthalmol. 2015;133(2):140-145. doi:10.1001/jamaophthalmol.2014.4301 PubMedGoogle ScholarCrossref
2.
Amaro  D , Carreño  E , Steeples  LR , Oliveira-Ramos  F , Marques-Neves  C , Leal  I .  Tubulointerstitial nephritis and uveitis (TINU) syndrome: a review.   Br J Ophthalmol. 2020;104(6):742-747. doi:10.1136/bjophthalmol-2019-314926 PubMedGoogle ScholarCrossref
3.
Mackensen  F , Smith  JR , Rosenbaum  JT .  Enhanced recognition, treatment, and prognosis of tubulointerstitial nephritis and uveitis syndrome.   Ophthalmology. 2007;114(5):995-999. doi:10.1016/j.ophtha.2007.01.002 PubMedGoogle ScholarCrossref
4.
Goda  C , Kotake  S , Ichiishi  A , Namba  K , Kitaichi  N , Ohno  S .  Clinical features in tubulointerstitial nephritis and uveitis (TINU) syndrome.   Am J Ophthalmol. 2005;140(4):637-641. doi:10.1016/j.ajo.2005.04.019 PubMedGoogle ScholarCrossref
5.
Joyce  E , Glasner  P , Ranganathan  S , Swiatecka-Urban  A .  Tubulointerstitial nephritis: diagnosis, treatment, and monitoring.   Pediatr Nephrol. 2017;32(4):577-587. doi:10.1007/s00467-016-3394-5 PubMedGoogle ScholarCrossref
6.
Pakzad-Vaezi  K , Pepple  KL .  Tubulointerstitial nephritis and uveitis.   Curr Opin Ophthalmol. 2017;28(6):629-635. doi:10.1097/ICU.0000000000000421 PubMedGoogle ScholarCrossref
7.
Saarela  V , Nuutinen  M , Ala-Houhala  M , Arikoski  P , Rönnholm  K , Jahnukainen  T .  Tubulointerstitial nephritis and uveitis syndrome in children: a prospective multicenter study.   Ophthalmology. 2013;120(7):1476-1481. doi:10.1016/j.ophtha.2012.12.039PubMedGoogle ScholarCrossref
8.
Koreishi  AF , Zhou  M , Goldstein  DA .  Tubulointerstitial nephritis and uveitis syndrome: characterization of clinical features.   Ocul Immunol Inflamm. 2020;28:1-6. doi:10.1080/09273948.2020.1736311 PubMedGoogle Scholar
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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