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History may explain young patient’s bilateral uveitis
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PHILADELPHIA – An 11-year-old soft contact lens wearer may have developed bilateral uveitis from an unlikely source, according to a lecturer here at the PCON Symposium.
The girl, a 5-D myope, complained of blinking and squinting for about a month. “The child described incredible light sensitivity,” said lecturer Marlane J. Brown, OD, FAAO, a PCON columnist. “She couldn’t look straight at people.”
The girl’s anterior chamber showed “2+ cells and flare. Her conjuctiva was white and quiet,” Dr. Brown continued. Her history included overwear and a spate of recent vaccinations.
Dr. Brown diagnosed the girl with bilateral uveitis and asked the audience what their next step might be. “Had she been worked up for rheumatoid arthritis?” asked Michael D. DePaolis, course director, PCON editor and Dr. Brown’s co-lecturer.
Dr. Brown said she called the girl’s pediatrician to confer, and they both agreed the patient should be tested for juvenile inflammatory arthritis, among other conditions. A complete blood work-up was ordered.
“On examination you really do need to narrow down the differential diagnosis,” Dr. Brown told the audience. “Optimize your laboratory testing. Direct your appropriate referrals and do a complete examination of the eye and adnexa.” With arthritis, the uveitis usually occurs about 2 years after onset of those symptoms, Dr. Brown explained.
“This patient was otherwise healthy when she first came in to see me,” she said. The patient returned a week later for a follow-up. Her uveitis had since cleared up, but her blood work did not provide a clear-cut reason for it. “Her workup was negative, no signs of rheumatoid, no signs of juvenile inflammatory arthritis,” Dr. Brown said.
Upon further questioning, the girl’s mother said she had complained of wrist and ankle pain after receiving DPT (diphtheria, pertussis and tetanus) and pneumococcal vaccines.
Dr. Brown said she did further research and came to the conclusion that there was a link between the vaccines and the patient developing bilateral uveitis. “The pediatrician tried to dismiss it, but I believe that was the cause,” she said.