CASE PRESENTATION

PATIENT
• 18 years old girl

• Resident of Pune

• XIIth standard
PRESENTING COMPLAINTS
1) Swelling of multiple joints x 14 years (since 4 years of age)

2) Intermittent skin colored raised lesions over upper extremities &

face x 11 years (since 7 years of age)

3) Blurring of vision (RE>>LE) x 2 years

 PRESENTING COMPLAINTS

Swelling of multiple joints x 14 years

• Involving both the wrist and ankles

• Insidious onset gradually progressive over next 06 months Static for 7-8
years Reduced ~10% with treatment and is static now since last 4 years

• No pain/stiffness/reduced range of motion/any other joint involvement

 PRESENTING COMPLAINTS
Multiple skin colored raised lesions over upper extremities &
face x 11 years

• Pin head sized  Over both the upper extremities & face

• Lasts for 2-3 months Spontaneously resolved without sequalae

• One episode/year

• No pain/itching/oozing/relation with joint or eye symptoms

 PRESENTING COMPLAINTS
Blurring of vision (Rt>>Lt) x 2 years
• Rt Eye Acute onset, static till date
• Blurring, black spots in the field of vision
• Also involved Lt Eye since last 2 wks (less severe wrt Rt eye)
• H/O similar episode (Rt eye only) 09 years back which resolved
completely in 01 month with some medication Associated with
redness
• No pain/redness (this episode)/photophobia/discharge/preceding
trauma
NEGATIVE HISTORY
No H/O
• Fever
• Leg ulcers
• Erythema nodosum
• Breathlessness/ Chronic cough
• Photosensitivity/ oral ulcers/genital ulcer
• Similar complaints in family
PERSONNEL HISTORY
• NAD
 TREATMENT HISTORY

• 2007-till date: Mtx started (Injection till 2009 Oral 7.5-15 mg/wk)

• 2007-14: Tab Medrol 2mg

• 2012-2018: HCQ 200mg OD

• 2014-till date: Tab prednisolone 5-10 mg (Intermittently)

• 2019-20: Prednisolone e/d

• 2020-21: Homatropine e/d

 INVESTIGATIONS/EYE Review

• 2005: FNAC (synovial proliferation with effusion), RA factor/ASO –ve

• 2006: Nebular corneal opacities, Post synechiae at 6/2/8 ‘o’ clock (Iritis), CXR:
WNL, Ferritin: WNL
• 2012: Festooned pupil (B/L), Slight haze medially (RE), Optic disc (WNL), B/L KP’s

• 2015: ANA –ve (1:40),

• 2017: Ferritin (WNL),

• 2018: (Synovial biopsy) Granulomatous synovitis,
• 2021: ACE levels (WNL), EYE (F/S/O chronic ant uveitis)
Skin biopsy
• 2011: (B/1162/11) Mild spongiosis, exocytosis, Dermis had large
collection of epithelioid cells and macrophages. RBC extravasation

• 2018: (B/1737/2018) Dermis had discrete epithelioid cell granuloma.

No caseation necrosis, asteroid bodies, schaumann syndrome; S/O
Granulomatous lesion (Sarcoid/TB)
 Examination
Skin
• Upper limbs (extensor & flexor surface) >>face: Multiple grouped skin colored
papules
• Face: also has grade 1 acne

Joints
• Swelling of both the wrist and ankle joints: diffuse swelling
• No tenderness, range of motion: full
• No signs of inflammation
THANK YOU