A case of recurrent bilateral optic oedema in tubulo‐interstitial nephritis and uveitis syndrome treated with plasmapheresis

Purpose To present a case of recurrent bilateral optic oedema in a patient with tubulo‐interstitial nephritis and uveitis syndrome (TINU) with a limited response to corticosteroids, immunosuppressive drugs and tumor necrosis factor inhibitor (TNFi). Plasmapheresis was added as rescue therapy. Method...

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Bibliographic Details
Published in:Acta ophthalmologica (Oxford, England) England), 2017-09, Vol.95 (S259), p.n/a
Main Authors: Dhaese, S., Dehoorne, J., Willemot, J.B., Sys, C., Leroy, B.P., Vande Walle, J., De Schryver, I.
Format: Article
Language:English
Subjects:
Anterior chamber
Apheresis
Azathioprine
Corticoids
Corticosteroids
Edema
Exudates
Exudation
Immunosuppressive agents
Infliximab
Methotrexate
Monoclonal antibodies
Nephritis
Plasmapheresis
Tacrolimus
Tapering
Tumor necrosis factor-α
Uveitis
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Summary:Purpose To present a case of recurrent bilateral optic oedema in a patient with tubulo‐interstitial nephritis and uveitis syndrome (TINU) with a limited response to corticosteroids, immunosuppressive drugs and tumor necrosis factor inhibitor (TNFi). Plasmapheresis was added as rescue therapy. Methods Observational case report about a 13‐year‐old boy diagnosed with TINU and bilateral optic oedema. An extensive general and ophthalmological work‐up confirmed the diagnosis of TINU. Results At referral the patient presented with bilateral anterior uveitis and nephritis. Biomicroscopy showed a trace of anterior chamber cells. Funduscopy revealed bilateral optic oedema with neither haemorrhages nor exudates. Initially the patient responded well to systemic corticosteroids but he relapsed while tapering. Consecutive treatment consisted of azathioprine, tacrolimus and methotrexate. Due to limited response, infliximab, a TNFi, was associated. After 7 months disease‐free, the TNFi treatment failed. Finally, he responded well to plasmapheresis. Conclusions TINU may rarely manifest with optic oedema. Although nephritis typically resolves, ocular inflammation often becomes chronic and can be therapy‐resistant. This case suggests that plasmapheresis can be an alternative in case of a therapy‐resistant TINU. A multidisciplinary approach is essential to confirm the diagnosis and initiate appropriate treatment.
ISSN:1755-375X
1755-3768
DOI:10.1111/j.1755-3768.2017.0T082