History of Present Illness
A 28-year-old Caucasian man with complains of mild redness, floaters, photophobia, and blurred vision in both eyes (OU) that began 2 weeks ago. He previously had excellent visual acuity (VA) with a mild myopic correction. He mentions that he has lost 20 pounds over the past 2 months and has malaise and weakness.
| OD | OS | |
|---|---|---|
| Visual acuity | 20/40 | 20/30 |
| Intraocular pressure (IOP) (mm Hg) | 9 | 8 |
| Purple-red skin lesions on lower lid ( Fig. 42.1 ). Mild ciliary flush. | No skin lesions on lids. Mild ciliary flush. | |
| Cornea | Nongranulomatous keratic precipitate (KP) in Arlts triangle | Nongranulomatous KP in Arlts triangle |
| Anterior chamber (AC) | 1+ flare and 1+ cells | 1+ flare and 1+ cells |
| Iris | No posterior synechiae. Argyll Robinson pupil | No posterior synechiae Argyll Robinson pupil |
| Lens | Clear | Clear |
| Vitreous cavity | 1+ vitreous cells | 1+ vitreous cells |
| Retina/optic nerve | Small white dots (<{1/4} disc diameter) scattered throughout the posterior and peripheral retina ( Fig. 42.1A and B ) | Small white dots (<{1/4} disc diameter) scattered throughout the posterior and peripheral retina. Optic disc edema |
Questions to Ask
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Have you been diagnosed with a sexually transmitted disease (STD)?
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Have you used intravenous (IV) drugs or had sex with high-risk partners?
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Do you have any skin lesions?
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Have you been tested for infection with acquired immunodeficiency virus (AIDS)?
He responds that no, he has not been diagnosed with an STD, and he denies IV drug use, but he is a man who has sex with other men (MSM). He recently noticed a subconjunctival hemorrhage inside his left lower eyelid, which has been present for over 2 months ( Fig. 42.2A ), and he has been bothered by a rash on his hands for over 3 months ( Fig. 42.2B ).
