Case Presentation

By:
Armaan Ashraf Ali Lambe
V9070020
Chief Complain:
48-year-old Female pt c/o of 1/12 hx of photophobia, tearing, and
eye pain in both eyes.

History:
Pt is HIV+ on ART 1 year ago when her CD4 count was <50.
After ART, her CD4 count > 250. She was doing well until one month
ago when she complained of increasing redness and eye pain in
both eyes.
PMH:
No N/V, headaches – R/O Glaucoma, Vitrous Hemorrhage
No increase in floaters or flashing lights – R/O Retinal Detachment
No complains of Discharge – R/O Conjunctival Infection
No hx of diabetes, trauma to the face or eyes or surgical hx, eye infections, use of drugs
except ARVs, No oral or genital ulcers reported.

Physical Exam:
Pupils: Irregular shape. Reactive, No RAPD
IOP: Normal
EOM: Full
VF: Normal
Fundal: normal retina, no cells in the humour.
SLE: notable for marked conjunctival injection, ciliary flush and large keratic precipitates
(KP) on the corneal endothelium. There was central posterior synechia around the pupil
margin. (Synechia = adhesions that attach iris to the trebecular meshwork).
Diagnostic Tests:
Serology for Syphillis -ve
Tuberculin Test +ve

Summary:
Pt, HIV+ve, presenting with photophobia, tearing, decreased vision, eye pain;
previously low CD4 but now picked up, Recent Tuberculin test +ve, mutton fat
Keratic Precipitates, with synechia indicating chronic granulomatous
inflammatory process. Which could mean either TB, Syphillis or Sarcoidosis.

Working Diagnosis: TB Uveitis after immune reconstitution syndrome.

Differentials: Sarcoidosis, Syphillis, MS, SLE.

Treatment: Prednisolone Drops (for inflammation), Scopolamine (dilatation and

prevention of synechial formation), Referred to Infectious diseases for further
 References
University of Iowa - Case6 - TB Uveitis