Author Block: Maryam I. T. Al-Najjar, Eric Fortin
Author Disclosure Block: M.I.T. Al-Najjar: None. E. Fortin: Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); advisory boards for AbbVie. Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); grants from allergan, gilaed and abbvie.

Abstract Body:

Purpose: To report a younger child presented with symptoms and signs of chronic bilateral intermediate uveitis associated with progressive demyelinating lesions on brain magnetic resonance imaging(MRI).
Study Design: Case Report.
Methods: Retrospective medical chart review including full ophthalmological examination ,ocular imaging and brain imaging.
Results: A five year old healthy child presented for the first time to our clinic complaining of symptoms of blurry of vision and floaters. Full ophthalmological examination as well as ocular imaging was performed. He was diagnosed to have bilateral intermediate uveitis as defined by the SUN criteria. Complete work-up was initiated to exclude the infectious and non-infectious causes. Brain MRI was obtained prior to initiate anti-TNF-alpha therapy and revealed multiple non enhancing foci of hyperintense signal within subcortical and periventricular white matter at the supratentorial level. The patient was neurologically asymptomatic. A follow-up brain MRI was done after one year which revealed new demyelinating lesions. The patient was considered to have radiologically isolated syndrome(RIS) and he did not receive anti-TNF-alpha agents.
Conclusions: A quarter of pediatric uveitis cases are intermediate uveitis(IU) and are mostly idiopathic. In comparison with intermediate uveitis in adults, pediatric IU has a worse visual prognosis. Some of the diseases associated with adult intermediate uveitis, such as multiple sclerosis(MS) and intraocular lymphoma, are rare in children but the association between IU in childhood and an increased risk of developing MS as an adult has been reported. However, there are no reports in the literature of patients with intermediate uveitis developing MS or RIS during childhood. The case that we are reporting has important clinical implications in the present era of increased use of anti-TNF-alpha agents to treat pediatric uveitis. Anti-TNF-alpha agents are contraindicated in patients with MS as the early studies show worsening of neurological signs and symptoms in these patients. Although pediatric MS is an uncommon condition, thought should be given to CNS MRI screening of patients with IU if anti-TNF-alpha therapy is considered. To our knowledge, this is the first case report of a child with intermediate uveitis associated with central nervous system(CNS) demyelinating lesions. However, it is highly probable that this association is under estimated because clinicians do not routinely obtain CNS MRIs in pediatric patients with intermediate uveitis.