A Recalcitrant Case of Eye Redness: A Case Report of Tubulointerstitial Nephritis & Uveitis in a Healthy Young Female
Purpose
To report a young female with no known comorbidities and risk factors presenting with recurrent eye redness.
Methods
A 29-year-old Asian female presented at our clinic for bilateral eye redness that initially was treated with topical steroids. This provided resolution of symptoms. However, on discontinuation of the medication the redness would recur and the treatment would be restarted, this cycle would continue until further workup was done. There were signs of bilateral nongranulomatous anterior segment inflammation and the rest of the ophthalmologic examination was unremarkable The workup revealed revealing elevated inflammatory markers (CRP & ESR) and signs of kidney involvement (elevated creatinine, urinalysis findings of albumin 2+ and WBC 25-30/HPF). The patient was restarted on a longer course of topical steroids and further work up was done revealing elevated Beta 2 Microglobulin.
Results
The patient was then managed as a case of tubulointerstitial nephritis & uveitis (TINU) syndrome and started on systemic steroids while topical steroids were weaned off. On discontinuation of topical steroids, there was an immediate recurrence of eye redness and inflammation. Immunomodulatory therapy, methotrexate, was added to the regimen providing stable control of anterior segment inflammation for close to two years.
Conclusion
Cases of recurrent and persistent eye redness should raise suspicions for clinicians for a more serious underlying pathology. Proper workup should be initiated and reviewed despite a patient’s clinically healthy appearance. For cases of TINU, multiple forms of treatment may be needed to treat the disease and prevent further complications
Conflict of interest
No
Authors 1
Last name
GUANZON
Initials of first name(s)
GNI
Department
Quirino Memorial Medical Center Department of Ophthalmology
City
Quezon City
Country
Philippines
Authors 2
Last name
Garcia
Initials of first name(s)
CM
Department
Quirino Memorial Medical Center Department of Ophthalmology
City
Quezon City
Country
Philippines
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