In this case report, we describe the case of a 50-year-old woman referred by her general practitioner to a pulmonologist in order to investigate persistent fever and elevation of C-reactive protein despite antibiotic treatment following a respiratory infection. The patient was examined extensively, during which rheumatology, gastroenterology, nephrology, ophthalmology, laboratory and imaging tests were performed. Due to a rapid progression of renal insufficiency with active urinary sediment, the patient was referred for a renal biopsy, which confirmed tubulointerstitial nephritis, followed by a diagnosis of bilateral anterior uveitis two months later - genetic testing was also conducted, which confirmed the diagnosis of tubulointerstitial nephritis with uveitis syndrome. Steroid treatment brought about a gradual reduction of proteinuria and a stabilisation of renal function.
- Keywords
- TINU syndrome, Uveitis, mCRP, tubulointerstitial nephritis, uveitis,
- MeSH
- Glucocorticoids MeSH
- Nephritis, Interstitial * complications diagnosis drug therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Syndrome MeSH
- Uveitis * complications diagnosis drug therapy MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- Names of Substances
- Glucocorticoids MeSH
- MeSH
- Middle Aged MeSH
- Humans MeSH
- Uveitis, Anterior etiology MeSH
- Colitis, Ulcerative complications MeSH
- Uveitis etiology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- English Abstract MeSH
- Journal Article MeSH
AIM: The aim of the article is to summarize observations on cytomegalovirus (CMV) anterior uveitis, and in short case reports present cases of patients treated at our Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague. MATERIAL AND METHODS: Retrospective analysis of patients at the Centre for diagnosis and treatment of uveitis from 2003 to 2024. Presentation of our experiences with CMV anterior uveitis confirmed by polymerase chain reaction (PCR) in aqueous humor in case reports. RESULTS: From a cohort of 3844 patients with uveitis, 3 patients were diagnosed with CMV anterior uveitis, confirmed by PCR in the aqueous humor. The clinical presentation was as acute recurrent hypertensive anterior uveitis in all patients, with a switch to chronic form with elevated intraocular pressure (IOP). Despite local anti-inflammatory and antiglaucomatous therapy, there was high recurrence of uveitis with decompensation of IOP when the medication was reduced. Patients underwent antiglaucoma surgery because of persistent high IOP despite maximal local antiglaucomatous therapy. An anterior chamber tap was taken for PCR analysis, with a CMV-positive result. After the initiation of antiviral therapy with local ganciclovir, patients manifested compensated IOP and a pronounced reduction of recurrences of uveitis and progression of glaucoma. CONCLUSIONS: CMV anterior uveitis is a rare pathology in our geographic region, but it is important to consider this etiology in cases of recurrent anterior hypertensive uveitis with a low response to local anti-inflammatory medication. Timely verification of the etiological agent with prompt diagnosis and treatment is essential in order to achieve a favorable prognosis. Long-term, low maintenance doses of antiviral therapy with local ganciclovir for several months reduce relapses of uveitis and lead to compensation of IOP.
- Keywords
- anterior uveitis, cytomegalovirus, ganciclovir, plasmapheresis, secondary glaucoma,
- MeSH
- Antiviral Agents therapeutic use MeSH
- Cytomegalovirus Infections * diagnosis drug therapy complications virology MeSH
- Cytomegalovirus isolation & purification genetics MeSH
- Adult MeSH
- Aqueous Humor virology MeSH
- Middle Aged MeSH
- Humans MeSH
- Uveitis, Anterior * virology diagnosis drug therapy MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Names of Substances
- Antiviral Agents MeSH
AIM: to investigate the dynamics of the T-cell immune response in rabbits with experimental autoimmune uveitis (EAU) of varying severity. MATERIALS AND METHODS: The experiment involved two groups of Chinchilla rabbits (15 rabbits in each group). The model of EAU was created. The clinical picture of intraocular inflammation of varying severity was assessed. The determination of the level of white blood cells (WBC), lymphocytes (Lymphs), CD3+, CD4+, CD8+, and CD16+ in the blood of rabbits was conducted. RESULTS: Group I - moderate and severe uveitis, Group II - uveitis of mild severity. WBC, Lymphs, CD3+, CD4+, CD16+ were elevated and statistically significant in both groups of animals compared to control parameters on all days of the experiment (3, 7, 10, 14, 21 days) (p.
- Keywords
- T-cells response, autoimmune uveitis, experiment,
- MeSH
- Autoimmune Diseases * immunology blood MeSH
- Rabbits MeSH
- Disease Models, Animal MeSH
- T-Lymphocytes immunology MeSH
- Uveitis * immunology blood MeSH
- Animals MeSH
- Check Tag
- Rabbits MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Keywords
- CATARACT/etiology *, UVEITIS/complications *,
- MeSH
- Cataract etiology MeSH
- Humans MeSH
- Uveitis complications MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Keywords
- LEPTOSPIROSIS *, SERODIAGNOSIS *, UVEITIS *,
- MeSH
- Leptospirosis * MeSH
- Humans MeSH
- Serologic Tests * MeSH
- Uveitis * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
AIMS: To analyse the hallmarks of ocular manifestations of and therapeutic modalities for syphilis in the last two decades. The clinical features of syphilitic uveitis, and association with the human immunodeficiency virus (HIV) coinfection are described. METHODS: Retrospective study of 16 patients diagnosed with ocular syphilis confirmed by serological tests in the General University Hospital in Prague between the years 2004 and 2021. General characteristics of ocular and systemic manifestations and visual functions were analysed. RESULTS: An increasing incidence of syphilitic uveitis correlates with a general rise in syphilis cases. In our study, the ocular manifestation of syphilis was panuveitis (44%), posterior uveitis (31%) and anterior uveitis (25%). Posterior uveitis was found in 3 patients (19%) associated with preretinal infiltrates, that are often present in syphilitic uveitis. The worst visual outcomes were among patients with human immunodeficiency virus (HIV) coinfection and/or neurosyphilis, however the data were not significant. Optic disc edema was present in 56%, macular involvement in 37% of patients. Overall, 31% of patients in our cohort had persistent visual field defects due to impairment of their optic nerve or macula despite the final median Snellen visual acuity of 1.0. Two out of sixteen patients were treated with corticosteroids in addition to antibiotics. CONCLUSION: Posterior uveitis with preretinal infiltrates and optic disc edema should arouse suspicion of ocular syphilis. Recent data show the advantages of adjacent systemic corticosteroid treatment for severe forms of syphilitic uveitis and/or neuritis. Our observation supports this finding.
- Keywords
- corticosteroids, optic disc edema, optic neuritis, syphilis, uveitis,
- MeSH
- HIV Infections * complications diagnosis drug therapy MeSH
- Coinfection * complications MeSH
- Humans MeSH
- Papilledema * complications MeSH
- Eye Infections, Bacterial * drug therapy diagnosis epidemiology MeSH
- Retrospective Studies MeSH
- Syphilis * complications drug therapy diagnosis MeSH
- Uveitis * drug therapy etiology diagnosis MeSH
- Uveitis, Posterior * complications MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic epidemiology MeSH
BACKGROUND: Autoimmune uveitis is a leading cause of visual impairment in developed countries in patients of working age. Animal models of experimental autoimmune uveitis (EAU) have been established to serve as a useful template for novel therapeutic approaches. METHODS: Experimental autoimmune uveitis is induced in C57BL/6 mice by subcutaneous application of interphotoreceptor retinoid binding protein in complete Freund's adjuvant and pertussis toxin. Clinical and histological grading is used to assess the inflammation intensity of EAU. RESULTS: The protocol of induction of EAU in mice hides several important aspects, which are crucial for developing the disease. These details have to be addressed to ensure reproducible disease induction. We describe our experience in establishing the model by pointing out the critical steps in EAU protocol which we found important. CONCLUSION: The mouse model of EAU has practical value for preclinical studies, is robust and well established. However, the induction of inflammation of the eye can be quite challenging when important details of the protocol are not recognized and adhered to.
- Keywords
- C57BL/6 mouse strain, chronic posterior autoimmune uveitis, experimental autoimmune uveitis, induction protocol, mouse model,
- MeSH
- Adjuvants, Immunologic MeSH
- Autoimmune Diseases chemically induced MeSH
- Chronic Disease MeSH
- Irritants MeSH
- Freund's Adjuvant MeSH
- Disease Models, Animal * MeSH
- Mice, Inbred C57BL MeSH
- Eye Proteins * MeSH
- Pertussis Toxin MeSH
- Retinol-Binding Proteins * MeSH
- Uveitis chemically induced MeSH
- Animals MeSH
- Check Tag
- Female MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Names of Substances
- Adjuvants, Immunologic MeSH
- Irritants MeSH
- Freund's Adjuvant MeSH
- interstitial retinol-binding protein MeSH Browser
- Eye Proteins * MeSH
- Pertussis Toxin MeSH
- Retinol-Binding Proteins * MeSH
- Keywords
- LEPTOSPIROSIS/complications *, UVEITIS/etiology *,
- MeSH
- Leptospirosis complications MeSH
- Humans MeSH
- Uveitis etiology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
AIMS: Cases of infectious uveitis in immunodeficient patients may present with atypical clinical features because the clinical course of disease is usually affected by the compromised immune system. Therefore, it is sometimes difficult to determine the correct diagnosis. The aim of this study was to evaluate a prevalence of immunodeficient HIV-negative individuals among patients with infectious uveitis and to assess diagnostic and therapeutic approaches. METHODS: A retrospective study. RESULTS: In years 2003-2017, we diagnosed 594 patients with infectious uveitis. In 35 of them, infectious uveitis occurred on the basis of immunodeficiency (malignancy, immunosuppressive therapy etc.). The most common infectious uveitis was cytomegalovirus retinitis, followed by acute retinal necrosis, herpetic anterior uveitis, endogenous fungal endophthalmitis, toxoplasmic retinochoroiditis, progressive outer retinal necrosis and syphilis. In indicated cases, intraocular fluid examination was a valuable diagnostic tool. After initiation of treatment, improvement of BCVA was observed in 13 eyes, stabilization in 13 eyes and deterioration in 11 eyes. In some patients who experienced adverse effects of medication, the recommended doses were decreased. CONCLUSION: Our experience shows that patients with diagnoses of acute retinal necrosis or progressive outer retinal necrosis have a poor visual prognosis. The occurrence of cytomegalovirus retinitis signifies a very unfavorable survival prognosis in patients who underwent hematopoietic stem cell transplantation; the patients in our study died within 1 year from cytomegalovirus retinitis diagnosis.
- Keywords
- cytomegalovirus retinitis, fungal endophthalmitis, herpetic retinal necrosis, immunodeficiency, toxoplasmic retinochoroiditis,
- MeSH
- Adult MeSH
- Immunocompromised Host * MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Eye Infections, Viral diagnosis etiology physiopathology therapy MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Uveitis diagnosis etiology physiopathology therapy MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
