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Atypical Bilateral Fuchs Uveitis: Diagnostic Challenges.

Couto C, Hurtado E, Faingold D, Demetrio C, Schlaen A, Zas M, Zarate J, Rosetti S, de Lima AP, Croxatto JO, Chiaradía P, Burnier MN - Case Rep Ophthalmol (2015)

Bottom Line: After extensive systemic workup, including vitrectomy, the case had no identifiable systemic etiology.IVCM of the cornea revealed the presence of dendritiform keratic precipitates.A high index of suspicion is key to an early diagnosis, especially in the cases with vitreous opacities and posterior segment manifestations.

View Article: PubMed Central - PubMed

Affiliation: Uveitis, Retina and Cornea Clinics, Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina.

ABSTRACT

Unlabelled: Bilateral Fuchs uveitis associated with vitreous infiltration and posterior segment involvement requires a thorough diagnostic evaluation. The lack of well-defined diagnostic criteria makes identification of this entity difficult. The aim of this case report was to present the characteristics of a patient with atypical Fuchs uveitis and the procedures needed to rule out the differential diagnosis with specific attention to the utility of in vivo confocal microscopy (IVCM).

Case report: One case of chronic bilateral uveitis with severe vitreous opacities is presented. After extensive systemic workup, including vitrectomy, the case had no identifiable systemic etiology. IVCM of the cornea revealed the presence of dendritiform keratic precipitates.

Conclusion: The diagnosis of Fuchs uveitis is based on clinical findings as no confirmatory laboratory tests are available. A high index of suspicion is key to an early diagnosis, especially in the cases with vitreous opacities and posterior segment manifestations. Auxiliary tests such as IVCM may aid the clinician in the diagnosis of Fuchs uveitis.

No MeSH data available.


Related in: MedlinePlus

IVCM features of OU.
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Figure 3: IVCM features of OU.

Mentions: The patient was diagnosed with bilateral FU based on the diagnostic criteria [3]. However, due to the age of the patient and the severity of the vitreous haze despite having received extensive treatment with corticosteroids and immunosuppressive agents, we attempted to rule out a second diagnosis: primary ocular lymphoma. Neurological evaluation did not reveal any underlying disease, and the MRI and cerebrospinal fluid analysis were normal. A diagnostic vitrectomy was performed in her OS without complications. The cytopathological study showed isolated polymorphonuclear cells, lymphocytes, histiocytes, erythrocytes and amorphous material (fig. 3). Flow cytometry showed B cells (92%), without signs of atypia (atypical cells). The diagnosis of lymphoma was ruled out. The patient improved her visual acuity to 20/20 (OS) without signs of anterior uveitis or vitreous haze. Due to vitreous opacity in her right eye, a vitrectomy was performed in order to improve the symptoms and for diagnostic purposes. The cytopathological study was negative for lymphoma, and PCR was negative for HSV, HZV, CMV, toxoplasmosis and rubella. The patient recovered her visual acuity to 20/20 in OU without recurrence of the vitreous haze and anterior uveitis OU. In order to reinforce the clinical diagnosis of FU, we performed an IVCM evaluation of both corneas. The study revealed isolated dendritic cells at the basal membrane and stromal hyperreflective deposits. The endothelium showed polymegethism and numerous cells with long and spider web extensions and cell clusters that could correspond to cells with hyperchromatic round nuclei (lymphocytes) and hyperreflective punctate deposits that could correspond to pigmented cells (melanosomes). Mean endothelial cell density was lower in both corneas. The findings were highly consistent with FU.


Atypical Bilateral Fuchs Uveitis: Diagnostic Challenges.

Couto C, Hurtado E, Faingold D, Demetrio C, Schlaen A, Zas M, Zarate J, Rosetti S, de Lima AP, Croxatto JO, Chiaradía P, Burnier MN - Case Rep Ophthalmol (2015)

IVCM features of OU.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608646&req=5

Figure 3: IVCM features of OU.
Mentions: The patient was diagnosed with bilateral FU based on the diagnostic criteria [3]. However, due to the age of the patient and the severity of the vitreous haze despite having received extensive treatment with corticosteroids and immunosuppressive agents, we attempted to rule out a second diagnosis: primary ocular lymphoma. Neurological evaluation did not reveal any underlying disease, and the MRI and cerebrospinal fluid analysis were normal. A diagnostic vitrectomy was performed in her OS without complications. The cytopathological study showed isolated polymorphonuclear cells, lymphocytes, histiocytes, erythrocytes and amorphous material (fig. 3). Flow cytometry showed B cells (92%), without signs of atypia (atypical cells). The diagnosis of lymphoma was ruled out. The patient improved her visual acuity to 20/20 (OS) without signs of anterior uveitis or vitreous haze. Due to vitreous opacity in her right eye, a vitrectomy was performed in order to improve the symptoms and for diagnostic purposes. The cytopathological study was negative for lymphoma, and PCR was negative for HSV, HZV, CMV, toxoplasmosis and rubella. The patient recovered her visual acuity to 20/20 in OU without recurrence of the vitreous haze and anterior uveitis OU. In order to reinforce the clinical diagnosis of FU, we performed an IVCM evaluation of both corneas. The study revealed isolated dendritic cells at the basal membrane and stromal hyperreflective deposits. The endothelium showed polymegethism and numerous cells with long and spider web extensions and cell clusters that could correspond to cells with hyperchromatic round nuclei (lymphocytes) and hyperreflective punctate deposits that could correspond to pigmented cells (melanosomes). Mean endothelial cell density was lower in both corneas. The findings were highly consistent with FU.

Bottom Line: After extensive systemic workup, including vitrectomy, the case had no identifiable systemic etiology.IVCM of the cornea revealed the presence of dendritiform keratic precipitates.A high index of suspicion is key to an early diagnosis, especially in the cases with vitreous opacities and posterior segment manifestations.

View Article: PubMed Central - PubMed

Affiliation: Uveitis, Retina and Cornea Clinics, Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina.

ABSTRACT

Unlabelled: Bilateral Fuchs uveitis associated with vitreous infiltration and posterior segment involvement requires a thorough diagnostic evaluation. The lack of well-defined diagnostic criteria makes identification of this entity difficult. The aim of this case report was to present the characteristics of a patient with atypical Fuchs uveitis and the procedures needed to rule out the differential diagnosis with specific attention to the utility of in vivo confocal microscopy (IVCM).

Case report: One case of chronic bilateral uveitis with severe vitreous opacities is presented. After extensive systemic workup, including vitrectomy, the case had no identifiable systemic etiology. IVCM of the cornea revealed the presence of dendritiform keratic precipitates.

Conclusion: The diagnosis of Fuchs uveitis is based on clinical findings as no confirmatory laboratory tests are available. A high index of suspicion is key to an early diagnosis, especially in the cases with vitreous opacities and posterior segment manifestations. Auxiliary tests such as IVCM may aid the clinician in the diagnosis of Fuchs uveitis.

No MeSH data available.


Related in: MedlinePlus