HTLV1 Associated Uveitis

A patient presented to the Bascom Palmer Eye Institute with complaints of floaters in the left eye for 3 years and the right eye for 3 months. Vision was best corrected to 20/25 in both eyes. Anterior segment exam revealed fine KP in both eyes without significant anterior segment cell or flare. Posterior 2+ vitreous cell and a posterior vitreous detachment was present in both eyes without any retinal lesions. Imaging with OCT revealed vitreous and pre-retinal inflammation with a normal foveomacula in both eyes. Fluorescein angiography of both eyes showed evidence of peripheral small vessel leakage. A diagnosis of bilateral intermediate uveitis was made and the patient was started on topical prednisolone. Laboratory evaluation showed leukocytosis and negative tests for tuberculosis, syphilis, sarcoidosis, and HLA-B27. Three months later the patient developed shortness of breath which lead to inpatient evaluation. Computed tomography of the chest identified pleural effusion, mediastinal lymphadenopathy, and multiple lung nodules. PET-CT showed increased and abnormal uptake in areas of lymphadenopathy. Flow cytometry revealed CD4+CD25+ cells and western blot was positive for HTLV1. A diagnosis of adult T cell lymphoma and HTLV-1 associated uveitis was made. The patient underwent treatment with zidovudine, interferon, and belinostat and is currently in remission at one year follow-up with persistent bilateral intermediate uveitis.

Presentation Date: 03/10/2022

Issue Date: 03/18/2022