Case report.
RESULTS: A 16-year-old boy with
traumatic brain injury and
seizures presented to the emergency department with facial swelling,
rash, and
back pain several days after increasing
lamotrigine dose secondary to a breakthrough seizure.
Creatinine, urine β2 microglobulin, and eosinophils were elevated.
Antinuclear antibodies,
antineutrophil cytoplasmic antibodies,
angiotensin-converting enzyme, and
complement were normal. Renal biopsy showed acute granulomatous
tubulointerstitial nephritis.
Lamotrigine was discontinued, intravenous
steroids were initiated, and the patient was discharged on
Ativan and
prednisone. Subsequently, he was diagnosed with bilateral
anterior uveitis (vision 20/30 bilaterally) and started on
prednisolone and
cyclopentolate. Two months later, he developed a
branch retinal artery occlusion in the right eye (vision 20/70) and bilateral
ocular hypertension for which
timolol-
brimonidine and
dorzolamide were added. Neuroimaging and
hypercoagulability workup was unremarkable. Vision and intraocular pressure improved, while
uveitis remained recalcitrant. Several months later, the patient developed
central serous retinopathy in the right eye (vision 20/30).
Prednisone was stopped but restarted due to
methotrexate intolerance. A month later, he reported
dizziness and was diagnosed with severe bilateral
sensorineural hearing loss. Brain magnetic resonance imaging showed foci of perivascular, subcortical, and cochlear enhancement. Transtympanic Decadron
injections and
infliximab infusions were initiated. At the final visit, vision remained at 20/30 with trace anterior chamber reaction bilaterally while on
timolol-
brimonidine,
dorzolamide, and
prednisolone.
CONCLUSIONS: