Tubulointerstitial nephritis and uveitis (TINU) syndrome and recentStreptococcusinfection in a 9-year-old girl

Abstract

A 9-year-old girl presented to hospital with a 6-week history of non-specific constitutional symptoms and weight loss. She initially underwent extensive medical investigation without diagnosis being achieved. Although raised inflammatory markers and impaired renal function were noted during her initial admission to hospital, it was her subsequent presentation 2 weeks later with sudden-onset bilateral anterior uveitis that prompted a renal biopsy that indicated acute tubulointerstitial nephritis. A diagnosis of tubulointerstitial nephritis and uveitis (TINU) syndrome was made and systemic glucocorticoid treatment initiated to prevent visual loss and preserve renal function. She has subsequently been reviewed in multidisciplinary outpatient clinics and treated with a tapering regimen of immunosuppressive therapy. Her treatment has been complicated by the side effects of glucocorticoids and by persistent relapses in ocular disease and abnormalities on urinalysis. Recent clinical investigations indicate that her uveitis is controlled and that renal function remains well preserved.

TINU syndrome - literature review

“…Do tej pory udokumentowane przypadki powiązano z następującymi wirusami: Epstein-Barr [19,20] i varicella zoster [21]. Znane są też opisy zespołu TINU, które rozwinęły się przy wcześniejszym zakażeniu bakteriami z rodzaju Streptoccocus grupa A [22], aczkolwiek udział tego patogenu w rozwoju zespołu TINU ciągle nie został dobrze zrozumiany [23]. Wiadomo jednak, że może dojść do zapalenia błony naczyniowej oka w wyniki infekcji powyższą bakterią [24].…”