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Iris Mass and Panuveitis in a Child


History of Present Illness

A 4-year-old healthy male with no past medical history presents to the eye clinic complaining of redness of the right eye (OD) for 2 weeks. He had been placed on topical prednisolone four times a day (QID) OD without improvement.

Exam
OD OS
Visual Acuity Fix and follow Fix and follow
Intraocular pressure (IOP) 16 14
Sclera/conjunctiva Conjunctival congestion inferiorly White and quiet
Cornea Clear Clear
Anterior chamber (AC) 2+ cells1+ flare Deep and quiet
Iris Posterior synechiae, iris mass at 6 o’clock (see Fig. 19.1A and B ) Unremarkable
Lens Pigment on anterior lens surface Clear
Anterior vitreous 2+ vitreous cell Clear
Dilated fundus examination (DFE) See Fig. 19.2A See Fig. 19.2B

Anterior segment fluorescein angiography (FA), fundus FA, and optical coherence tomography (OCT) were all pursued.

Fig. 19.1, (A) External photograph of the right eye shows multiple posterior synechiae, pigment on the anterior lens capsule, an irregular pupil, and an angle mass inferonasally. (B) A magnified view of the mass. (C) Anterior segment fluorescein angiography showed leakage from the iris mass without neovascularization of the iris. (D) Ultrasound biomicroscopy demonstrates a solid iris mass.

Fig. 19.2, (A) Color fundus photograph of the right eye. There are multiple chorioretinal lesions, mild vitreous hemorrhage inferiorly, and mild disc edema. (B) Color fundus photograph of left eye demonstrates multiple yellow chorioretinal lesions. (C and D) Fundus fluorescein angiography of both eyes shows early hypofluorescence and late hyperfluorescence of the chorioretinal lesions. (E) Spectral-domain OCT of the right eye shows shallow subretinal fluid temporally. (F) Spectral-domain OCT of the left eye shows no subretinal fluid.

Questions to Ask

  • Has the patient had fevers, chills, cough, shortness of breath, joint pain/swelling/stiffness, diarrhea, blood in urine/stool, skin rashes, or oral/genital ulcers?

  • Any history of weight loss?

  • Any recent history of travel or contact with sick people?

The patient had a history of diarrhea several months before presentation, which resolved after 3 weeks without treatment. He and his parents replied no to all other questions.

Assessment

  • Panuveitis OD

  • Angle mass OD

  • Chorioretinal lesions and papillitis left eye (OS)

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