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Adult Onset Tubulointerstitial Nephritis and Uveitis Syndrome-A Case Report
腎小管間質腎炎與葡萄膜炎症候群－病例報告
摘要
目的：我們報告一名有腎臟切片確認之腎小管間質腎炎與葡萄膜炎症候群病例。 方法：病例報告。 結果：一位29歲有三次前葡萄膜炎發作病史的男性，主訴左眼無痛性視力模糊約一週，同時間出現兩側下肢水腫。到院時右眼最佳矯正視力20/20，左眼最佳矯正視力20/40。眼底檢查發現雙眼前房皆有發炎反應。尿液分析發現有蛋白尿，血清有大幅上升之血尿素氮和肌酸酊，顯示為急性腎衰竭發作。經皮腎臟切片之病理檢查發現急性腎小管間質腎炎，證實為腎小管間質腎炎與葡萄膜炎症候群(tubulointerstitial nephhtis and uveitis syndrome)。病患使用局部及全身性類固醇五個月後，葡萄膜炎消失，左眼視力回復到20/20。 結論，腎小管間質腎炎與葡萄膜炎症候群是造成葡萄膜炎的病因中，可能被輕忽的一個疾病。眼科醫師在腎小管間質腎炎與葡萄膜炎症候群的診斷上扮演重要的第一線角色。在面對葡萄膜炎時進行完整的內科評估，將有助於發現病因並做出正確的治療計畫。
關鍵字
無資料並列摘要
Purpose: To report a case of biopsy-proven tubulointerstitial nephritis and uveitis (TINU) syndrome involving the posterior segment. Method: Case report. Results: A 29-year-old male had suffered from painless blurred vision in the left eye for one week. The patient had the history of bilateral anterior uveitis. Initially, his best spectacle corrected visual acuity (BSCVA) was 20/20 in the right eye and 20/40 in the left eye. The ocular examination revealed cells and flares in the bilateral anterior chambers. Fundus examination showed macular exudates, intraretinal hemorrhage, sheathing of retinal vessels, and optic disc edema. Laboratory tests revealed elevated serum creatinine (3.8 mg/dl) and lood urea nitrogen (BUN) (48.3 mg/dl). Percutaneous renal biopsy showed cute tubulointerstitial nephritis. In addition, we excluded other diseases which an cause both acute nephritis and uveitis, such as Sjögren syndrome, ehçet' disease and systemic lupus erythematosus (SLE). The diagnosis of ubulointerstitial nephritis and uveitis syndrome was established. The patient as treated with topical prednisolone and cycloplegics. Intravenous pulse therapy of methylprednisolone (1 gm daily) was also given for three days, followed by oral prednisolone 60 mg daily. Ocular inflammation and optic disc edema in both eyes were resolved and BSCVA of 20/20 was achieved in the left eye after six-month follow-up. Conclusion: TINU syndrome is probably an under-diagnosed cause of uveitis. Ophthalmologists play an important role in the initial discovery of patients with TINU syndrome. A thorough medical evaluation of any patient presenting with uveitis and systemic disease is crucial to early diagnosis and appropriate management.