Cutaneous nodules, granulomatous uveitis and oligoarthritis in child
History of Present Illness
A 5-year-old girl presented with a complaint of red eye and blurred vision left eye (OS) for the past 4 months. She had a history of pneumonia at 4 years of age, which required hospitalization. Shortly afterward she developed a swollen, painful right knee and left interphalangeal joint. For the past 6 months, erythematous, plaquelike, and scaly lesions were observed on her right hand ( Fig. 29.1 ), buttocks, and feet.
Exam
| OD | OS | |
|---|---|---|
| Visual acuity | 20/20 | 20/40 |
| Intraocular pressure (IOP) (mm Hg) | 12 | 10 |
| Sclera/conjunctiva | Within normal limits (WNL) | No ciliary injection. |
| Cornea | WNL | Diffuse mutton fat keratic precipitate (KP) on the inferior half of corneal endothelium |
| Anterior chamber (AC) | WNL | 2+ flare, 2+ cell |
| Iris | WNL | One Koeppe nodule on the pupillary margin ( Fig. 29.2 ) |
| Lens | Clear | Clear |
| Vitreous cavity | WNL | 2+ vitritis |
| Retina/optic nerve | WNL | Mild perivasculitis extending to the periphery |
Cutaneous erythematous, plaquelike, and scaly lesions on both hands.
From Artac H, Bozkurt B, Talim B, Reisli I Sarcoid-like granulomas in common variable immunodeficiency. Rheumatol Int. 2009;30:109–112.
