Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan.
Department of Ophthalmology, Healh Sciences University of Hokkaido, Sapporo, Japan.
BMC Ophthalmol. 2023 Oct 20;23(1):424. doi: 10.1186/s12886-023-03172-0.
Tubulointerstitial nephritis and uveitis (TINU) syndrome is an uveits characterized by complications of idiopathic acute tubulointerstitial nephritis, and most cases present only anterior uveitis. We report a case of TINU syndrome in which the presence of choroiditis was revealed by multimodal imaging.
A 12-year-old male visited our hospital with a 6-day history of ocular pain and hyperemia. Conjunctival and ciliary injections, 1 + flare and 3 + cells of anterior chamber inflammation with mutton fat keratic precipitates were observed in both eyes (OU), together with redness and swelling of the optic disc OU. Laboratory tests showed slightly high levels of soluble IL-2R and serum β2 microglobulin and markedly high levels of urinary β2 microglobulin. The diagnosis of probable TINU syndrome was established on the basis of bilateral uveitis and urinalysis results in accordance with a clinical criteria of tubulointerstitial nephritis. With treatment with oral prednisolone (PSL) at 20 mg/day, ocular findings improved, and the dose of PSL was gradually reduced and withdrawn 6 months later. However, 1 month later from the withdrawal, ocular inflammation recurred with the presence of retinal exudates and snowball vitreous opacities in the peripheral retina OU. Fluorescein angiography showed leakages from peripheral retinal vessels and staining corresponding to retinal exudates. Indocyanine green angiography showed hypofluorescent dots scattered over the ocular fundus. Optical coherence tomography revealed the presence of choroidal thickening. Laser speckle flowgraphy color map showed a relatively cooler color. Findings from these multimodal images indicated the presence of subclinical choroiditis; therefore, oral PSL was administered again, and ocular inflammatory findings were improved.
TINU syndrome can exhibit subclinical choroiditis detected with multimodal imaging. Further studies are necessary to determine the frequency of subclinical choroiditis in TINU syndrome.
小管间质性肾炎和葡萄膜炎（TINU）综合征是一种以特发性急性小管间质性肾炎并发症为特征的葡萄膜炎，大多数病例仅表现为前葡萄膜炎。我们报告了一例 TINU 综合征病例，该病例通过多模态成像显示出脉络膜炎的存在。
一名 12 岁男性因眼部疼痛和充血 6 天就诊于我院。双眼均出现结膜和睫状体充血，1+前房闪辉和 3+细胞，伴有角膜后羊脂状沉淀物的前房炎症，同时伴有双眼视盘红肿。实验室检查显示可溶性白细胞介素 2 受体和血清β2 微球蛋白略有升高，尿液β2 微球蛋白明显升高。根据双侧葡萄膜炎和尿分析结果，并结合小管间质性肾炎的临床标准，诊断为可能的 TINU 综合征。口服泼尼松龙（PSL）20mg/天治疗后，眼部表现改善，PSL 剂量逐渐减少，并在 6 个月后停药。然而，停药后 1 个月，眼部炎症再次发作，出现视网膜渗出物和周边视网膜雪球状玻璃体积血。荧光素血管造影显示周边视网膜血管渗漏和与视网膜渗出物相对应的染色。吲哚青绿血管造影显示眼底散在低荧光点。光学相干断层扫描显示脉络膜增厚。激光散斑血流图彩色图谱显示颜色较冷。这些多模态图像的结果表明存在亚临床脉络膜炎；因此，再次给予口服 PSL，眼部炎症表现改善。
TINU 综合征可表现出多模态成像检测到的亚临床脉络膜炎。需要进一步研究以确定 TINU 综合征中亚临床脉络膜炎的频率。
