Tubulointerstitial Nephritis and Uveitis Syndrome During the COVID-19 Pandemic: A Case Series

Turk J Ophthalmol. 2024 Feb 22;54(1):5-10. doi: 10.4274/tjo.galenos.2023.24280.


Objectives: To report the ocular findings, laboratory results, and management of patients with tubulointerstitial nephritis and uveitis syndrome (TINU), whose numbers increased during the 2019 coronavirus disease (COVID-19) pandemic.

Materials and methods: Demographic characteristics, ophthalmic examination findings, laboratory results including polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), serum SARS-CoV-2 immunoglobulin G (IgG) antibody, and treatment of patients diagnosed with TINU between March 2020 and March 2022 were evaluated retrospectively.

Results: The study included 19 eyes of 10 patients (6 female/4 male). The mean age was 13.5±2.4 years (range: 8-16 years). The mean follow-up duration was 13.5±6.1 months (range: 6-24 months). All patients presented with anterior uveitis. Anterior uveitis was bilateral in 9 patients (90%) and unilateral in 1 patient (10%). Posterior segment findings were normal in 8 patients (80%), and bilateral optic disc edema was observed in only 2 patients (20%). None of the patients had a previous SARS-CoV-2 infection and/or vaccination history. The SARS-CoV-2 PCR test was negative in all patients at presentation. The SARS-CoV-2 IgG antibody test was reactive in 7 patients (70%). Recurrent uveitis developed in 8 patients (80%) during follow-up. Systemic immunomodulatory therapy was required for the control of ocular inflammation in 7 patients (70%) with severe uveitis flare-ups.

Conclusion: TINU is a multisystemic autoimmune disease, especially in response to environmental triggering factors such as viral infections. Although TINU is a rare disease, the number of cases increased during the COVID-19 pandemic. SARS-CoV-2 antibodies were detected at a significant rate of 70% in these patients, who did not have a history of SARS-CoV-2 infection and vaccination. Previous asymptomatic SARS-CoV-2 infection in children may be a triggering factor in the development of TINU.

Keywords: COVID-19; SARS-CoV-2; TINU; pediatric uveitis; tubulointerstitial nephritis; uveitis.

MeSH terms

  • Adolescent
  • COVID-19* / epidemiology
  • Child
  • Female
  • Humans
  • Male
  • Nephritis, Interstitial*
  • Pandemics
  • Retrospective Studies
  • SARS-CoV-2
  • Uveitis* / diagnosis
  • Uveitis* / epidemiology
  • Uveitis, Anterior*

Supplementary concepts

  • Tubulointerstitial nephritis and uveitis