To report a case of an 86-year-old white British female who had a 5-day history of right eye blurred vision. She was treated previously for macular oedema secondary to retinal vein occlusion. She had a history of osteoarthritis and heart failure.
Methods
Clinical examination
Results
Examination showed right anterior uveitis and she was given steroid drops. One week later, the right eye vision worsened and she had intense anterior uveitis, vitritis and branch retinal artery occlusion, but no retinitis. Fundus fluorescein angiogram could not be completed because of patient's syncoptic episode. The blood tests were normal, but for positive ANA and p-ANCA. She was seen in stroke clinic and she had no new systemic vascular findings and rheumatology review showed no systemic inflammation. Her carotid doppler, chest and head imaging were normal. We started oral steroids and the inflammation initially resolved. However, 8 weeks later, while on low dose oral steroids, she had right eye recurrent vitritis and active retinitis. A vitreous biopsy showed viral infection, but no malignancy. She was started oral Valaciclovir, but she could not tolerate very well. So, we switched to oral Aciclovir and right eye intravitreal Foscarnet injection. After 4 weeks, there was no response and another vitreous biopsy was performed, considering the diagnosis of lymphoma and amyloid. The second vitreous sample showed normal ratio of T&B cells and no amyloid, but Toxoplasma PCR was positive.
Conclusion
Thus, the patient was started oral Azithromycin and steroids. Following this treatment the vitritis regressed. However, she developed tractional retinal detachment and is under observation.
Conflict of interest
No
Authors 1
Last name
TASIOPOULOU
Initials of first name(s)
A
Department
Royal Devon and Exeter Hospital-RDE
City
Exeter
Country
United Kingdom
Authors 2
Last name
RAMSDEN
Initials of first name(s)
C
Department
RDE
City
Exeter
Country
United Kingdom
This website uses cookies to ensure you get the best experience on our website.
Learn more