Tubulointerstitial Nephritis and Uveitis Syndrome with unilateral enthesopathy of the knee joint

Introduction

Tubulointerstitial nephritis and uveitis syndrome is an inflammatory granulomatous syndrome that was first described in two patients by Dobrin et al. in 1975. Classically, patients present with renal impairment secondary to acute interstitial nephritis, as well as bilateral anterior uveitis, bone marrow granulomas, hypergammaglobulinemia and an increased erythrocyte sedimentation rate (Dobrin RS et al. Am J Med. 1975; 59: 325 – 333). It is a rare disease with often delayed diagnosis. Its approximate prevalence in Northern Ireland was 3.5 cases per million with an incidence of 0.2/million/year (Sinnamon KT et al. NDT Plus. 2008; 1: 112 – 116). The median age of onset is 15 years with a 3:1 female-to-male predominance, although an older average age distribution has also been described (Mandeville JT et al. Surv Ophthalmol. 2001; 46: 195 – 208, Sinnamon KT et al. NDT Plus. 2008; 1: 112 – 116). The exact etiology is unknown and several contributing factors have been reported including cell-mediated immunity precipitated by prior infections with Epstein-Barr virus, herpes zoster virus and chlamydia trachomatis, non-steroidal agents or antibiotics (Mandeville JT et al. Surv Ophthalmol. 2001; 46: 195 – 208, Birnbacher R et al. Pediatr Nephrol. 1995; 9: 193 – 195, Cigni A et al. Am J Kidney Dis. 2003; 42: E4 – 10, Stupp R et al. Klin Wochenschr. 1990; 68: 971 – 975). Studies have noted the coexistence of other systemic diseases, including rheumatoid arthritis, hyperthyroidism and hyperparathyroidism (Mandeville JT et al. Surv Ophthalmol. 2001; 46: 195 – 208, Catalano C et al. Am J Kidney Dis. 1989; 14: 317 – 318, Paul E et al. Pediatrics. 1999; 104: 314 – 317). However, joint involvement in tubulointerstitial nephritis and uveitis syndrome has been rarely described. Only, a few reported cases have described sacroiliac and hip joints manifestations in tubulointerstitial nephritis and uveitis syndrome (Cigni A et al. Am J Kidney Dis. 2003; 42: E4 – 10, Levy M et al. Contrib Nephrol. 1979; 16: 132 – 140, Mangat P et al. Rheumatology (Oxford). 2008; 47: 933 – 936).