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. 80-year-old woman : en el abtract pone 84 años: hay que ponerlo igual submitted (en lugar de referred) ophthalmology department en lugar de department of ophthalmology

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 VISUAL ACUITY : 20/40 OU SLIT LAMP BIOMICROSCOPY : Anterior bilateral granulomatous uveitis FUNDUS EXAMINATION Moderate vitritis. Bilateral disk edema Bilateral cystoid macular edema (OCT). Haemorrhagic retinopathy 80-year-old woman : en el abtract pone 84 años: hay que ponerlo igual submitted (en lugar de referred) ophthalmology department en lugar de department of ophthalmology

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 TBC, SYPHILIS, LYME DISEASE.. MRI (brain and orbits): It was negative for malignancy Chest x-ray: Hilar lymphadenopathies CT : thymic or pleuropericardial cyst Hilar and paratracheal lymphadenopathies Interstitial lung pattern Vitreous biopsy: was read as negative for malignancy. ( No monoclonal CD20 , 19 y 45 LB, IL10/1L6 no >3,2). Were only observed monocytes and LT TB-screening: Mantoux negative, Quantyferon-TB negative. Syphilis Serology ( treponemic and no treponemic test). Borrelia burgdorferi serology negative. 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 CD4 / CD8 = 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 1mg/kg/day for 10 days.. And thereafter, slow tapering and large- treatment with low prednisone dosis.. ( < 10mg /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 Esta imagen es tras el tratamiento, no???? This image is after treatment?