Bilateral Posterior Uveitis with Retinitis Revealing Primary Sjögren’s Syndrome
DOI:
https://doi.org/10.12974/2309-6136.2018.06.04Keywords:
Posterior uveitis, Uveitis, Retinitis, Primary Sjögren’s syndrome, Sicca syndrome, Retinal vasculitis.Abstract
Introduction: Ocular manifestations are frequent during primary Sjögren's syndrome (PSS) and largely dominated by the signs of xerophthalmia. The extra-glandular ocular involvement is, on the contrary, exceptional and unusual. We are reporting an original case of bilateral posterior uveitis with retinitis inaugural of PSS.
Case report: A 48-year-old Tunisian woman, with no notable pathological history, was explored for progressive decline in visual acuity, bilateral visual blur, and moderate eye pain.
The examination noted a visual acuity at 6/10 on the left and 5/10 on the right, without redness of the eyes or irritative signs. The anterior segment of both eyes was normal.
Ophthalmologic exam (slit lamp, fundus, and retinal angiography) revealed bilateral, non-granulomatous posterior uveitis associated with retinitis and retinal vasculitis.
Further investigations concluded to PSS and treatment with intravenous pulse methylprednisolone followed by oral prednisone was introduced. The evolution was rapidly favorable and ophthalmological exam with eye fundus was totally normal at two months.
Conclusion: PSS remains an exceptional and unusual cause of uveitis. It is therefore appropriate to evoke it in front of any uveitis that does not prove itself, especially if recidivating.
References
Choi W, Lee SS, Park YG, Yoon KC. A case of necrotizing keratoscleritis in primary Sjogren's syndrome. Korean J Ophthalmol. 2011; 25(4): 275-7. https://doi.org/10.3341/kjo.2011.25.4.275
Maślińska M, Przygodzka M, Kwiatkowska B, Sikorska- Siudek K. Sjögren's syndrome: still not fully understood disease. Rheumatol Int. 2015; 35(2): 233-41. https://doi.org/10.1007/s00296-014-3072-5
Luciano N, Valentini V, Calabrò A, Elefante E, Vitale A, Baldini C, et al. One year in review 2015: Sjögren's syndrome. Clin Exp Rheumatol. 2015; 33(2): 259-71.
Shiboski CH, Shiboski SC1, Seror R2, Criswell LA1, Labetoulle M2, Lietman TM1, et al. 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren's syndrome: A consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis. 2017; 76(1): 9- 16. https://doi.org/10.1136/annrheumdis-2016-210571
Tincani A, Andreoli L, Cavazzana I, Doria A, Favero M, Fenini MG, et al. Novel aspects of Sjögren's syndrome in 2012. BMC Med. 2013; 11: 93. https://doi.org/10.1186/1741-7015-11-93
Ramos-Casals M, Brito-Zerón P, Solans R, Camps MT, Casanovas A, Sopeña B, et al. Systemic involvement in primary Sjogren's syndrome evaluated by the EULAR-SS disease activity index: analysis of 921 Spanish patients (GEAS-SS Registry). Rheumatology (Oxford). 2014; 53(2): 321-31. https://doi.org/10.1093/rheumatology/ket349
Mathews PM, Hahn S, Hessen M, Kim J, Grader-Beck T, Birnbaum J, et al. Ocular complications of primary Sjögren syndrome in men. Am J Ophthalmol 2015; 160(3): 447- 452.e1. https://doi.org/10.1016/j.ajo.2015.06.004
Patel SJ, Lundy DC. Ocular manifestations of autoimmune disease. Am Fam Physician. 2002; 66(6): 991-8.
Rosenbaum JT, Bennett RM. Chronic anterior and posterior uveitis and primary Sjögren's syndrome. Am J Ophthalmol 1987; 104(4): 346-52. https://doi.org/10.1016/0002-9394(87)90223-6
Stoffel PB, Sauvain MJ, von Vigier RO, Beretta-Piccoli BC, Ramelli GP, Bianchetti MG. Non-infectious causes of uveitis in 70 Swiss children. Acta Paediatr 2000; 89(8): 955-8. https://doi.org/10.1111/j.1651-2227.2000.tb00416.x
Chebil A, Baroudi B, Slim M, Chaker N, Lamloum M, Bouladi M, et al. Epidemiology of uveitis in the Tunis area. J Fr Ophtalmol 2013; 36(9): 764-8. https://doi.org/10.1016/j.jfo.2013.05.006
Khairallah M, Yahia SB, Ladjimi A, Messaoud R, Zaouali S, Attia S, et al. Pattern of uveitis in a referral centre in Tunisia, North Africa. Eye (Lond). 2007; 21(1): 33-9. https://doi.org/10.1038/sj.eye.6702111
