A case of tubulointerstitial nephritis and uveitis syndrome accompanied by subclinical choroiditis

Background: Tubulointerstitial nephritis and uveitis (TINU) syndrome is an uveits characterized by complications of idiopathic acute tubulointerstitial nephritis, and most cases present only anterior uveitis. We report a case of TINU syndrome in which the presence of choroiditis was revealed by multimodal imaging. Case presentation: A 12-year-old male visited our hospital with a 6-day history of ocular pain and hyperemia in the left eye (OS). Moderate anterior segment inflammation was found, without any inflammatory findings in the posterior segment OS. A few days later, ocular inflammatory findings appeared including in the right eye (OD). Conjunctival and ciliary injections, 1+ flare and 3+ cells of anterior chamber inflammation, and mutton fat keratic precipitates were observed in both eyes (OU). In addition, redness and swelling of the optic disc were observed OU. Laboratory tests showed slightly high levels of soluble IL-2R and serum β2 microglobulin and markedly high levels of urinary β2 microglobulin. The diagnosis of probable TINU syndrome was established on the basis of presenting bilateral anterior uveitis and in accordance with a clinical criteria of tubulointerstitial nephritis. Oral prednisolone (PSL) at 20 mg/day was given, and ocular findings improved. The dose of PSL was gradually reduced and withdrawn, but ocular inflammation recurred OU. Retinal exudates and snowball vitreous opacities were observed in the peripheral retina. Fluorescein angiography showed leakages from peripheral retinal vessels and staining corresponding to retinal exudates. Indocyanine green angiography showed hypofluorescent dots scattered over the ocular fundus. Optical coherence tomography revealed the presence of choroidal thickening. Laser speckle flowgraphy color map showed a relatively cooler color. Findings from multimodal imaging caused suspicion of a wide range of choroiditis; therefore, oral PSL was administered again. PSL was gradually tapered to 3 mg/day, and no anterior segment inflammation has been observed, but slight inflammatory findings in the posterior segment have persisted. Conclusions: : We describe a case of TINU syndrome complicated by subclinical choroiditis detected with multimodal imaging. Further studies are necessary to determine the frequency of subclinical choroiditis in TINU syndrome.