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anterior_uveitis_ddx [2025/01/22 15:11] – Scott Larsonanterior_uveitis_ddx [2025/04/18 20:40] (current) – external edit 127.0.0.1
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 ==== Causes ==== ==== Causes ====
-  * JRA-related iridocyclitis +  * Primarily Ocular  
-  * Behçet syndrome +    * Infectious 
-  * Fuchs heterochromic iridocyclitis +      * post-surgical (P. Acnes) 
-  * Glaucomacyclitic crisis (Posner Schlossman) +      * herpes viruses 
-  * Herpetic iritis +    * Post-traumatic iritis 
-  * Idiopathic +    * Fuchs heterochromic iridocyclitis 
-  * IOL- related iritis +    * Lens-related 
-  * Kawasaki syndrome +      * IOL related 
-  * Lens related Uveitis +      * Glaucomacyclitic crisis (Posner Schlossman) 
-  * Low-grade infectious endophthalmitis (P. acnes) +  * Systemic Non-infectious Disease 
-  * Sarcoidosis +    * [[jia_screening|Juvenile Idiopathic Arthritis]] 
-  * Seronegative spondyloarthropathies +    * [[behcets|Behçet syndrome]] 
-  * Syphilis +    * [[tubulointerstitial_nephritis_uveitis|Tubulointerstitial Nephritis and Uveitis (TINU)]] 
-  * Traumatic iritis+    * Sarcoidosis 
 +    * Kawasaki syndrome 
 +    * Juvenile onset spondyloarthropathies (HLA-B27 associated) 
 +      * Juvenile Ankylosing spondilitis 
 +      * Reactive arthritis 
 +      * Inflammatory Bowel disease related  
 +      * Psoriatic arthritis  
 +  * Systemic Infectious Diseases 
 +    * Post Infectious Autoimmune uveitis (streptococcal pharyngitis) 
 +    * Herpes Viruses (VZV, HSV) 
 +    * Syphilis 
 +    * Tuberculosis 
 +    * Lyme
  
 ==== Work-up for cases without an obvious cause ==== ==== Work-up for cases without an obvious cause ====
-  * Most patients with uveitis are worked up for sarcoidosis, syphilis, and tuberculosis. Other testing is based on history and exam; for example, a child with chronic bilateral anterior uveitis would have ANA testing because JIA is a likely diagnosis, and a teenager with severe acute anterior uveitis in 1 eye would be tested for HLA‑B27. Lyme testing is useful in a Lyme endemic area or following history of tick bite and characteristic rash.111 There is limited utility in a "shot gun" approach to uveitis testing, and the positive predictive value of every test must be considered. Testing for sarcoidosis includes a chest x‑ray and might include obtaining angiotensin-converting enzyme (ACE) serum and lysozyme levels.112 Although CT chest is often obtained looking for sarcoidosis in older patients,113 it should probably not be used as a screening tool in pediatric patients, because of the radiation dose.114 Testing for TB can be performed via skin testing (PPD) or serum interferon gamma assay such as the QuantiFERON Gold. Syphilis testing includes both nontreponemal testing such as RPR and VDRL and treponemal testing such as fluorescent treponemal antibody absorption test (FTA-ABS) or Treponema pallidum particle agglutination (TPPA). excerpt from  [[https://www.aao.org/education/disease-review/pediatric-anterior-uveitis|AAO Pediatric Anterior Uveitis]]+  * Consider working up for:  
 +    * Sarcoidosis 
 +      * **angiotensin-converting enzyme (ACE)** and serum lysozyme levels 
 +      * followed by chest x-ray 
 +      * followed by Chest CT 
 +    * Syphilis 
 +      * Non-treponemal testing 
 +        * **RPR** -or- 
 +        * VDRL 
 +      * Followed by treponemal testing 
 +        * fluorescent treponemal antibody absorption (FTA-ABS) -or- 
 +        * Treponema pallidum particle agglutination (TPPA) 
 +    * Tuberculosis 
 +      * **Serum QuantiFERON Gold** or PPD 
 +    * Herpes viruses 
 +      * **HSV PCR** 
 +      * VZV PCR 
 +    * JIA without significant arthritis- **ANA** 
 +    * TINU 
 +      * **urinary β2 microglobulin** 
 +      * **BUN, Creatinine** 
 +      * **urinalysis** (looking for proteinuria, normoglycemic glycosuria, microheaturia, sterile pyuria) 
 +    * Lyme titers in endemic areas or travel to endemic areas 
 +      * **Lyme DNA PCR**  or Lyme Disease AB Western Blot 
 +    * HLA-B27 in teenagers 
 +    * Mascarade diseases (leukemia, lymphoma) 
 +      * **CBC** 
 +====Work up based on history and exam findings==== 
 +  
 +  * Arthritis 
 +    * ANA 
 +  * Joint pain with chronic diarrhea and abdominal pain 
 +    * HLA-B27 
 +  * Rash 
 +    * Psoriasis  
 +      * rash areas are red, pink, or purple, dry, itchy, and scaly 
 +      * associated with arthritis  
 +    * Lyme 
 +      * erythema migrans  
 +        * red, blue or pink circular or oval with clear center, expands over several days, may reach up to 12 inches and have a raised border 
 +      * Travel to endemic areas, exposure to ticks 
 +      * Borrelia burgdorferi antibodies IgG, IgM  
 +  * Fever, Weight loss, fatigue, malaise, abdominal pain 
 +    * urinary β2 microglobulin, BUN, Creatinine, UA. ANA, HLA-B27, CBC 
 +  * Previous Strep throat (group A strep infection suspected 
 +    * Antistreptolysin O titers 
 +  
 +====Masquerades of Anterior Uveitis==== 
 +  * Leukemia 
 +  * [[retinoblastoma_international_classification|Retinoblastoma]] 
 +  * Juvenile Xanthogranuloma
  
 ==== References ==== ==== References ====
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-{{tag>ddx}}+{{tag>ddx uveitis}}