Case presentation: A 61-year-old doctor came from overseas for a second opinion to LV Prasad Eye Institute in February 2020. Progressive vision loss with recurrent redness for the past 3 months in his right eye Referred for a second opinion regarding management of glaucoma Regarding starting biologics Past medical history Had an episode of inflammation in his left eye in 2015 and recovered very quickly. Had onset of symptoms of redness and blurry vision on and off in his right eye for the past 4 years. He had consulted various ophthalmologists for these symptoms since 2016. He took various medications and underwent several investigations. The episodes would subside with the use of corticosteroid and anti-glaucoma medications. Received a subconjunctival dexamethasone injection 4 months ago. Benign prostatic enlargement and hyper IgE status Systemic history: known to be HLA-B27 positive since 2014 Undergone various investigations: All were negative or normal He was immunocompetent and because of his HLA-B27 history, he had undergone complete rheumatological evaluation. However, no systemic manifestations were detected. Family history: HLA-B27 positive in his father with ankylosing spondylitis. Treatment history: At the time of presentation The IOP was recorded a week ago was 40 mmHg. The patient was on the following medications: Oral methotrexate 15 mg a week for the past 4 months. Acyclovir once daily for the past 10 days (following a consultation in the US) Acetazolamide 250 mg 3 times a day (was intolerant) Pred acetate eye drops, 3 anti-glaucoma eyedrops along with nepafenac and cyclopentolate. Treatment Plan: To start infliximab because his condition was not improving. He was already on 3 oral and 6 topical medications and was very fed up. Following are the photographs shared by the referring ophthalmologist. After a month of treatment: Right eye after a month His visual acuity was 20/60, intraocular…
CMV endothelitis with recurrent anterior Uveitis misdiagnosed as HLA-B27 Uveitis
December 27, 2021 | 0 Comment