1. Unusual Uveitic CME Amir Hadayer, MD Ophthalmology & Visual Sciences
University of Louisville School of Medicine
January 2016 1

2. Presentation CC: Blurry vision OU for 6 MO HPI: 23 yo WF
Blurry vision, photophobia and floaters OU for 6 MO
Denies ocular pain, red eye or irritation
h/o ant. granulomatous uveitis + CME OU
Partial response to PO steroids, periocular Kenalog OU and PF OU
Off Tx currently

3. History POHx: none PMHx: occasional cold sores Meds: OCP
Allergies: PCN

4. Ophthalmic Exam RAPD – neg 20/30 BCVA -1.25 M -1.50 Full VF Intact EOM
5 mm irregular
Pupils 15
IOP 11
RAPD – neg

5. Ophthalmic Exam Intact L/L Quiet Conjunctiva
Mild endothelial dusting, no KP’s
Cornea
Deep, +0.5 cells, +1 flare
A/C PS
Iris
Clear, pigment on capsule
Lens
+2 cells
Vitreous
Normal disc, CME. Vessels and periphery WNL
Fundus

6. OD OS

8. 0:54
4:49

9. 0:20
0:34
5:23

10. Assessment / Plan
23 yo WF presenting with chronic granulomatous panuveitis (MFC) + CME OU with partial response to treatment
Plan:
Lab evaluation
40 mg prednisone PO

11. Results Cr, BUN: WNL ALT, AST, GGT, Bili T, Bili D: WNL
WBC, Hb, PLT: WNL
UA: m/p contamination
HSV IgM I/II combination: positive
CMV IgM: negative
EBV IgM: negative, IgG: positive
Varicella IgM: negative, IgG: positive
RPR: negative
Quantiferron: indetermined

12. MCP Bilateral Young myopic women
Small multiple yellowish choroidal lesions of the posterior pole
Evolve to punctate choroidal scars

14. Highlights IGRA can also react with atypical mycobacteria Case report:
66 yoM with recalcitrant CME s/p cataract + ERM peeling OS
4 x subtenon Kenalog injections failed
ICG: numerous choroidal hypofluorescent dots and fuzzy vessels OU
Quantiferron: positive, constitutional symptoms positive, CXR opacity
Bronchial aspirate positive for M. Kansasii
Following triple therapy uveitis subsided, CME resolved and BCVA improved.

19. References
Kuznetcova TI, Sauty A, Herbort CP. Uveitis with occult choroiditis due to Mycobacterium kansasii: limitations of interferon-gamma release assay (IGRA) tests (case report and mini-review on ocular non-tuberculous mycobacteria and IGRA cross-reactivity). Int Ophthalmol. 2012;32(5):
BSCS 9 Intraocular inflammation and uveitis

20. Thank you