58/Malay/Male

1
Presentation

• 58/Malay/Male
• 1 year history of blurring of vision R gt L
• PMH Hypertension, Gout
• No ulcers/urinary symptoms

2
Examination

• Right Left
• VA (aided) 6/45 6/15
• IOP 15 17
• Anterior chamber Trace cells 2 cells
• NS 4 NS 2
• Cornea Rt old interstitial keratitis
• Band keratopathy
• Rt corneal stromal vascularisation

3

• Fundal exam
• Rt eye hazy view
• Lt eye vitreous cells 2, cystoid macular oedema
• Diagnosis Rt old IK with bilateral intermediate
  uveitis (LgtR)

4
Investigations

• FBC TW 8.8 (Lymph 25.6, PMN 62)
• ESR 91mm/hr
• ANA Negative
• Anti-ds DNA Negative
• ANCA Negative
• CXR Normal
• RPR Reactive in 14 dilution
• TPHA Reactive in gt11280 dilution

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6

• Diagnosis
• Right interstitial keratitis (old)
• Bilateral intermediate uveitis (LgtR),
• Complicated by left cystoid macular oedema,
• Secondary to luetic disease

7
Management

• Gutt Prednisolone 1 Q3H BE
• Subtenons triamcinolone acetonide (for CMO)
• OCT 399 microns

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9
Management

• Referral to DSC, Kelatan clinic
• LP WBC 0 per mm3
• Gluc 3.1 mmol/L
• Chloride 121 mmol/L
• T. Protein 0.5 g/L
• RBC Few
• VDRL Non-reactive
• FTA/ABS IgG/IgM Non-reactive

10
Follow-up

• Imp Late latent syphilis
• Mx 3 x IM benzylpenicillin
• Further plans
• Monitor with serology titres
• Further review Resolution of uveitis
• Listed for right cataract surgery after 3 months
  of quiescence.