A case of recurrent bilateral optic oedema in tubulo‐interstitial nephritis and uveitis syndrome treated with plasmapheresis

PurposeTo present a case of recurrent bilateral optic oedema in a patient with tubulo‐interstitial nephritis and uveitis syndrome (TINU) with a limited response to corticosteroids, immunosuppressive drugs and tumor necrosis factor inhibitor (TNFi). Plasmapheresis was added as rescue therapy.MethodsObservational case report about a 13‐year‐old boy diagnosed with TINU and bilateral optic oedema. An extensive general and ophthalmological work‐up confirmed the diagnosis of TINU.ResultsAt referral the patient presented with bilateral anterior uveitis and nephritis. Biomicroscopy showed a trace of anterior chamber cells. Funduscopy revealed bilateral optic oedema with neither haemorrhages nor exudates. Initially the patient responded well to systemic corticosteroids but he relapsed while tapering. Consecutive treatment consisted of azathioprine, tacrolimus and methotrexate. Due to limited response, infliximab, a TNFi, was associated. After 7 months disease‐free, the TNFi treatment failed. Finally, he responded well to plasmapheresis.ConclusionsTINU may rarely manifest with optic oedema. Although nephritis typically resolves, ocular inflammation often becomes chronic and can be therapy‐resistant. This case suggests that plasmapheresis can be an alternative in case of a therapy‐resistant TINU. A multidisciplinary approach is essential to confirm the diagnosis and initiate appropriate treatment.