BILATERAL ANTERIOR UVEITIS ASSOCIATED WITH LYMPHOCYTIC COLITIS

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Presentation transcript:

BILATERAL ANTERIOR UVEITIS ASSOCIATED WITH LYMPHOCYTIC COLITIS Rubio Álvarez N, Ferrari D, Vleming Pinilla EN, XX. Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid INTRODUCTION Lymphocytic colitis is a microscopic colitis. It has an association with thyroid disease, medicaments,… Extraintestinal symptoms such as uveitis are rare. It could remit spontaneously or by symptomatic treatment. If not, it can be treated with budesonide, salicylates or systemic steroids.

CLINICAL CASE 65 yo man with blurred vision and both painfull eyes during 2 days. P.A.: Hypertension Dyslipidemia Ictus with SAH 18 years ago with residual vertical diplopia Vit.D deficiency Iatrogenic hypothyroidism by I131 of Graves's disease with benign thyroid nodule and thyroid orbitopathy No prior ophthalmologic disease referred Allergy to diclofenac

EXPLORATION Visual acuity: 0.9/0.9 BMC both eyes: Fine RKP and on anterior capsule Tyndall++++ Hipopion 0.5mm Fibrine in the anterior chamber FO : anterior vitritis+

RESULTS Complete serology (anti HIV, toxoplasma IgG, antiCMV, IgM ACV, Rosa bengala, rickettsia) and Mantoux (-) Treatment: Oral prednisone 60mg, topical dexamethasone and cyclopentolate Reumathology: Normal electrophoresis Normal bone densitometry Autoimmunity (complement, PRC, RF, HLA-B27, ANA) (-) Normal values of immunoglobulin status (IgA, IgG, IgM) Blood test: normal values of TSH

RESULTS Gastroenterology consutation because of 10 days of 10 diarrhoic deposition/day Colonoscopy+biopsy: Dx lymphocytic colitis Coprocolture (-) EVOLUTION 1 month and a half after treatment: Diarrhea remission V.A 1.2 Tyndall (-)

CONCLUSIONS Gastroenterology department suspects lymphocytic colitis ibuprofen-related versus thyroid disease (with normal TSH). Colitis remission seems to be related to oral prednisone treatment. Remind the importance of a good diagnostic process in patient with ophthalmic disease because its frequent association to systemic diseases.