Lee Andrew R, Sharma Sumit, Mahmoud Tamer H
Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
Retin Cases Brief Rep. 2017;11(2):100-103. doi: 10.1097/ICB.0000000000000299.
To report a case of tubulointerstitial nephritis and uveitis syndrome with a primary presentation of acute posterior multifocal placoid pigment epitheliopathy after use of lamotrigine.
Retrospective case report with ultra-widefield fundus imaging, optical coherence tomography, and fluorescein angiography.
A 19-year-old woman presented with decreased visual acuity and acute renal failure after starting lamotrigine. Her examination demonstrated 1+ anterior chamber cell and numerous white deep retinal plaque-like lesions predominantly in the macula in both eyes. After extensive ophthalmic and systemic evaluation, the patient was diagnosed with tubulointerstitial nephritis and uveitis syndrome with a primary presentation of acute posterior multifocal placoid pigment epitheliopathy. She had excellent visual recovery with topical and systemic steroids.
Acute posterior multifocal placoid pigment epitheliopathy is a rare but important clinical presentation of tubulointerstitial nephritis and uveitis syndrome. Oral corticosteroid treatment can be considered for tubulointerstitial nephritis but is generally not necessary for acute posterior multifocal placoid pigment epitheliopathy.
报告一例使用拉莫三嗪后以急性后极部多灶性扁平状色素上皮病变为主要表现的肾小管间质性肾炎和葡萄膜炎综合征病例。
采用回顾性病例报告，进行超广角眼底成像、光学相干断层扫描和荧光素血管造影。
一名19岁女性在开始使用拉莫三嗪后出现视力下降和急性肾衰竭。检查发现双眼前房有1+细胞，双眼黄斑区有大量白色深层视网膜斑块样病变。经过广泛的眼科和全身评估，该患者被诊断为肾小管间质性肾炎和葡萄膜炎综合征，主要表现为急性后极部多灶性扁平状色素上皮病变。经局部和全身使用类固醇治疗后，她的视力恢复良好。
急性后极部多灶性扁平状色素上皮病变是肾小管间质性肾炎和葡萄膜炎综合征一种罕见但重要的临床表现。对于肾小管间质性肾炎可考虑口服皮质类固醇治疗，但急性后极部多灶性扁平状色素上皮病变一般无需使用。
