Tzu-Lun Huanga, Yun-Chen Huangb, Kung-Hung Linc, Min-Muh Sheua, d, Rong-Kung Tsaia, d
a Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
b Department of Medicine, Tzu Chi University, Hualien, Taiwan
c Department of Neurology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
d Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan
A 55-year-old woman with chronic hepatitis C presented with acute painless, unilateral, granulomatous uveitis without other systemic symptoms. Ocular symptoms began 20 weeks after starting pegylated interferon alpha (IFN-α)-2a and ribavirin. The anterior granulomatous uveitis quickly improved after application of topical steroid. However, the vision of the right eye worsened 4 weeks later because of a new episode of vitritis with multiple snowballs along and in retinal vessels. These were nodular and/or segmental periphlebitis with candlewax drippings in appearance. Multiple granulomas persisted for 4 weeks and spontaneously disappeared after immediate discontinuation of IFN-α therapy. We reviewed eight additional granulomatous uveitis of presumed ocular sarcoidosis during IFN-α therapy in previous articles and all of these patients suffered from bilateral uveitis. However, our case was treated with IFN-α and resulted in unilateral granulomatous panuveitis. Sixteen weeks after discontinuation of IFN-α therapy, the patient recovered well with regards to vision and no recurrence occurred.
Granulomatous uveitis; Interferon alpha; Nodular periphlebitis; Ocular sarcoidosis