1. Bilateral panuveitis in aN ELDERLY woman
Dra. MC, ALVARADO VALERO, Dra. MT PEDRAZ PENALVA, Dr. JC ELVIRA CRUAÑES.
HOSPITAL UNIVERSITARIO DEL VINALOPO

2. 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

3. 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

4. Bilateral panuveitis in aN ELDERLY woman. Bilateral papilitis

5. Bilateral panuveitis. Fluorescein angiography

6. Bilateral panuveitis in aN ELDERLY woman. Differential diagnosis
PRIMARY INTRAOCULAR LYMPHOMA
INFECTIONS
TUBERCULOSIS, SYPHILIS, LYME DISEASE , HIV
SARCOIDOSIS

7. 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

8. 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

9. … “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

10. Panuveitis in AN ELDERLY woman: ….. FoLLOW-UP
Esta imagen es tras el tratamiento, no???? This image is after treatment?