J Korean Ophthalmol Soc.  2014 Aug;55(8):1257-1260.

A Case of Recurrent Uveitis in Autoimmune Liver Disease

• Kim JE
• Choo HG
• Yoon IN

Abstract

PURPOSE
To report a case of recurrent uveitis associated with autoimmune liver disease.
CASE SUMMARY
A 50-year-old female with severe fatigue and arthritis visited the ophthalmology department due to decreased visual acuity and discomfort in her right eye for ten days. She had intermittent injection and blurred vision in both eyes for 30 years. Slit lamp examination of her right eye showed keratic precipitates, pigment deposits on the anterior capsule of the lens and anterior chamber cells; fundus examination was normal without any sign of chorioretinitis. Inflammatory reaction was improved after steroid and cycloplegic eye drop treatment. Two months later, her left eye developed anterior uveitis. Inflammation was well controlled with steroid and cycloplegic eye drop treatment. To evaluate the cause of uveitis and associated systemic disease, serological testing was performed, and abnormal elevation of liver enzymes was detected. The patient was referred to the Gastroenterology Department and diagnosed with autoimmune liver disease. Oral ursodeoxycholic acid was prescribed. Liver function profile improved to normal range, and the patient is currently under routine follow-up with no sign of recurrent uveitis.
CONCLUSIONS
When a patient with recurrent uveitis presents symptoms such as nausea, fatigue, abdominal pain, jaundice or abnormal liver profile, association with autoimmune liver disease should be considered.

Keyword

Autoimmune hepatitis; Autoimmune liver disease; Uveitis

MeSH Terms

Abdominal Pain
Anterior Capsule of the Lens
Anterior Chamber
Arthritis
Chorioretinitis
Fatigue
Female
Follow-Up Studies
Gastroenterology
Hepatitis, Autoimmune
Humans
Inflammation
Jaundice
Liver
Liver Diseases*
Middle Aged
Nausea
Ophthalmology
Reference Values
Serologic Tests
Ursodeoxycholic Acid
Uveitis*
Uveitis, Anterior
Visual Acuity
Ursodeoxycholic Acid

Figure

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  Figure 1. Slit lamp photograph of the right eye: pigment deposits on the anterior capsule of the lens.

Reference

References

1. Peponis V, Kyttaris VC, Tyradellis C, et al. Ocular manifestations of systemic lupus erythematosus: a clinical review. Lupus. 2006; 15:3–12.

2. Stolwijk C, Van Tubergen A, Castillo-Ortiz JD, Boonen A. Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis. Ann Rheum Dis. 2013; Sep 2. [Epub].

3. Pras E, Neumann R, Zandman-Goddard G, et al. Intraocular inflammation in autoimmune disease. Semin Arthritis Rheum. 2004; 34:602–9.

4. Kanski JJ, Bowling B, Nischal K, et al. Clinical ophthalmology. 7th ed.Edinburgh: Elsevier;2011. p. 406.

5. Krawitt EL. Autoimmune hepatitis. N Engl J Med. 2006; 354:54–66.

6. Watt FE, James OF, Jones DE. Patterns of autoimmunity in primary biliary cirrhosis patients and their families: a populationbased cohort study. QJM. 2004; 97:397–406.

7. Teufel A, Weinmann A, Kahaly GJ, et al. Concurrent autoimmune diseases in patients with autoimmune hepatitis. Journal of clinical gastroenterology. 2010; 44:208–13.

8. Lim LL, Scarborough JD, Thorne JE, et al. Uveitis in patients with autoimmune hepatitis. Am J Ophthalmol. 2009; 147:332–8.

9. Romanelli RG, La Villa G, Almerigogna F, et al. Uveitis in autoimmune hepatitis: a case report. World J Gastroenterol. 2006; 12:1637–40.

10. Kamal A, Bhan A, Murray PI. Uveitis with autoimmune hepatic disorders. Ocul Immunol Inflamm. 2001; 9:267–72.

11. Santos PS, Oliveira L, Moraes MF, et al. Granulomatous uveitis, CREST syndrome, and primary biliary cirrhosis. Br J Ophthalomol. 2000; 84:548–9.

12. Longo DL, Fauci AS, Kasper DL, et al. Harrison's principles of internal medicine. 18th ed.2. New York: McGraw-hill medical;2012. p. 3588–96.

13. Jeong SH. Autoimmune liver disease. Clinical and Molecular Hepatology. 2011; 17(2s):15–21.

14. Beuers U, Rust C. Overlap syndromes. Semin Liver Dis. 2005; 25:311–20.

15. Kaplan MM, Gershwin ME. Primary biliary cirrhosis. N Engl J Med. 2005; 353:1261–73.

16. Bjornsson E, Talwalkar J, Treeprasertsuk S, et al. Patients with typical laboratory features of autoimmiune hepatitis rarely need a liver biopsy for diagnosis. Clin Gastroenterol Hepatol. 2011; 9:57–63.