Tubulointerstitial nephritis and uveitis syndrome (TINU syndrome) associated with Epstein-Barr virus

Abstract

Purpose. To report a case of tubulointerstitial nephritis associated with uveitis (TINU) syndrome associated with Epstein-Barr virus, which presented aggressive bilateral uveitis. Methods. Clinical evaluation, serologic testing, and renal biopsy were performed on a 16 year-old boy who presented with bilateral visual loss and constitutional symptoms. Results. Slit lamp biomicroscopy revealed bilateral anterior uveitis with posterior synechiae in both eyes. He was commenced on topical and systemic corticoid treatment. Systemic evaluation revealed renal failure. Renal biopsy confirmed the diagnosis of TINU syndrome. IgM serology was positive for Epstein-Barr virus. While the renal response was good, the uveitis required immunosuppression which resulted in resolution. Conclusions. There have been only 3 previously reported cases of TINU syndrome associated with acute Epstein-Barr infection. In TINU syndrome, it has been reported that microorganisms may act as triggers of the disease in patients who are genetically predisposed. TINU syndrome should be considered in the differential diagnosis of uveitis with constitutional symptoms.