Tuberculous Uveitis - Clinical Tree

History of Present Illness

A 25-year-old man noticed the vision in his left eye (OS) became blurry 2 weeks ago and is associated with a productive cough. His appetite has been poor recently, and he has lost 20 pounds in the past 2 months.

Exam

	OD	OS
Visual acuity	20/25	20/100
Intraocular pressure (IOP)	11	7
Sclera/conjunctiva	Within normal limits (WNL)	Clear, no injection
Cornea	Clear	Multiple multifocal (MF) keratic precipitates (KPs) on corneal endothelium
Anterior chamber (AC)	WNL	3+ flare and 3+ cell
Iris	WNL	Intermittent posterior synechiae, Koeppe iris nodules on pupillary margin ( Fig. 43.1 )
Lens	Clear	Clear
Vitreous cavity	Clear	2+ vitreous cell
Retina/optic nerve		Choroidal mass in posterior pole ( Fig. 43.2 ), with retinal vasculitis and perivascular sheathing. Mild optic disc swelling at temporal margin

Questions to Ask

Have you had blurry vision in either eye before?
Why have you been losing weight? Is your appetite good?
Have you been diagnosed with a systemic illness?
What medications are you taking?
Have you been exposed to anyone with a contagious disease?

He has not had blurry vision before. His appetite is poor, which he attributes to his recent chest infection. He is gay, and 2 years ago he was diagnosed positive for human immunodeficiency virus (HIV). He is currently on highly active antiretroviral therapy (HAART), and about 1 month ago visited a friend who had recently been diagnosed with pneumonia.