HIV Plus Uveitis: Call the...Rheumatologist?

Medscape—March 25, 2015

I am Dr. Stephen Paget, physician-in-chief emeritus at Hospital for Special Surgery and professor of medicine at Weill Cornell Medical College, both in New York City. I have an interesting case to share with you, one that does not often come to a rheumatologist. But as you will see, in this situation a rheumatologist was perhaps the only person who could pull this all together.

Two or 3 weeks ago, I saw a 50-year-old gentleman who presented to me with recurrent episodes of severe posterior uveitis with vasculitis. In 1984 he was found to have a positive fluorescent treponemal antibody absorption (FTA-ABS) test, indicating syphilis; a positive PPD (purified protein derivative); and a positive QuantiFERON, thought to be related to latent tuberculosis. Soon thereafter he was found to have HIV disease and is now on triple HAART (highly active antiretroviral therapy) and doing quite well, with an undetectable viral load.

During the past year, this man began to develop eye pain, redness, and photophobia. He was seen by an ophthalmologist who sent him to a uveitis specialist who made a diagnosis of posterior and anterior uveitis. The patient was treated with topical steroids with reasonable control initially, but eventually he needed to be placed on oral steroids, 10 or 15 mg daily or more, to control his uveitis.

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