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Tubulointerstitial Nephritis and Uveitis Syndrome (TINU)


History of Present Illness

A 42-year-old female with past medical history of biopsy-proven interstitial nephritis since 2008 presented for the first time 2 years after the onset of nephritis to the eye clinic with anterior uveitis that started 5 months ago. She was treated with systemic corticosteroids (CS). The treatment was stopped a month ago, and 3 days later she noticed worsening of vision ( Figs. 11.1 and 11.2 ).

Exam
OD OS
Visual acuity 20/40 20/25
IOP 15 15
Sclera/conjunctiva Minimal ciliary injection Minimal ciliary injection
Cornea Small granulomatous KP in lower half (see Fig. 11.1 ) Larger granulomatous KP in lower half (see Fig. 11.2 )
Anterior chamber (AC) Deep, 1–2+ cells Deep, 2+ cells
Iris Unremarkable Unremarkable
Lens Clear Clear
Anterior vitreous +2 cells +2 cells
Retina See Fig. 11.3 See Fig. 11.3

Fig. 11.1, (A, B) Anterior segment photograph of both eyes with granulomatous keratic precipitate (KP).

Fig. 11.2, Fundus photograph showing moderately hazy media (A, B) and snow balls in the periphery (C, D). Optic nerve and posterior pole had normal findings. There were no signs of vascular sheathing.

Questions to Ask

  • Have you ever had any numbness, tingling, weakness on one side of the body, or bowel or bladder problems? Is there any history of neurologic disorders in the family?

  • Have you noticed any recent ticks or tick bites on your body?

  • Have you had any cough, lung problems, or episodes of fever?

She answers no to all of these questions.

Assessment

  • Intermediate uveitis left eye greater than right eye (OS > OD)

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