Epithelial downgrowth masquerading as granulomatous anterior and intermediate uveitis with histopathologic evidence of 5-FU treatment

Colin P Froines; Alexander D Lin; Kaivon Pakzad-Vaezi; Gordana Juric-Sekhar; Caitlin S Latimer; Kathryn P Scherpelz; C Dirk Keene; Eissa M Hanna; Michael R Banitt; Luis F Gonzalez-Cuyar

doi:10.3205/oc000245

Epithelial downgrowth masquerading as granulomatous anterior and intermediate uveitis with histopathologic evidence of 5-FU treatment

GMS Ophthalmol Cases. 2024 Sep 23:14:Doc13. doi: 10.3205/oc000245. eCollection 2024.

Affiliations

¹ Department of Ophthalmology, University of Washington, Seattle, Washington, USA.
² Department of Ophthalmology, Kaiser Hawaii, Honolulu, Hawaii, USA.
³ Department of Ophthalmology, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Department of Laboratory Medicine and Pathology, Division of Neuropathology, University of Washington, Seattle, Washington, USA.
⁵ Department of Ophthalmology, Wellish Vision Institute, Las Vegas, Nevada, USA.
⁶ Department of Ophthalmology, Northwest Eye Surgeons, Arlington, Washington, USA.

Abstract

Purpose: Highlight an unusual case of epithelial downgrowth (EDG) masquerading as granulomatous anterior and intermediate uveitis with histopathologic evidence of 5-fluorouracil (5-FU) treatment.

Case description: A 33-year-old man presented after multiple corneal surgeries and neodymium-doped yttrium aluminum garnet (Nd:YAG) capsulotomies with subacute angle closure, pain, light sensitivity, and decreased vision. Exam was notable for granulomatous keratic precipitates, an opacified lens capsule, and vitreous cell/haze. An anterior chamber paracentesis was sent for 16 s (pan-bacterial) and 28 s (pan-fungal) rRNA polymerase chain reaction testing, which returned negative. Diagnostic argon laser photocoagulation was performed on the iris and lens capsule, which blanched upon laser photocoagulation, and subsequent iris biopsy confirmed the presence of epithelial downgrowth (EDG). The patient was treated with multiple injections of 5-FU with repeat biopsy demonstrating both a reduction and apparent resolution in epithelial cell burden after 5-FU.

Conclusion: This case demonstrates an unusual presentation of EDG in a young patient with granulomatous anterior and intermediate uveitis, where simple office-based procedures of Argon laser photocoagulation and anterior chamber paracentesis helped aid in diagnosis and management. Histopathological examination in serial specimens demonstrated the effect of 5-FU on EGD. To our knowledge, this case is the first to describe histopathological reduction in epithelial cell burden with sustained resolution.

Keywords: 5-FU; epithelial downgrowth; histopathologic correlation; masquerade; uveitis.

Publication types

Case Reports