[A case of multiple sclerosis with bilateral intermediate uveitis]

We describe a case of 20-year-old woman with visual impairment in her left eye. Her left visual acuity was 0.07 and an ophthalmoscopic examination demonstrated bilateral intermediate uveitis (IU). A neurological examination on admission revealed lower nasal quadrantanopsia in her left eye and an exaggerated right patellar tendon reflex. A T2-weighted MRI showed multiple high-intensity lesions in the bilateral periventricular region, corpus callosum, medulla. A short T1 inversion recovery MRI also showed a swollen left retrobulbar optic nerve and posterior thoracic cord lesion at Th 9 level. The latter longitudinal length was approximately 20 mm. Laboratory investigation demonstrated no abnormalities including an anti-aquaporin-4 antibody. A cerebrospinal fluid examination revealed an increased IgG-index (1.21) with oligoclonal IgG babds. Initially, a diagnosis of retrobulbar optic neuritis with IU was made. She received subtenon corticosteroid injection with intravenous methylprednisolone pulse and oral prednisolone therapy. An immediate improvement of her visual symptoms and MRI abnormalities was observed. Approximately 1 year later, a new high-intensity lesion in the right internal capsule was present on a follow-up T2-weighted brain MRI, established a diagnosis of multiple sclerosis (MS) based on the McDonald criteria in 2010. Previous reports in Japan demonstrated few cases of uveitis in patients with MS and this is the first report of MS with IU in Japan.