As an experienced mom of three school-age boys, Laura Whitton wasn't unusually concerned, at first, when her ten-year-old son, Avery, experienced what looked like ‘pink eye' and flu-like symptoms.
Illness had been going around his school, and the family had adjusted to life in China over the past two years as Whitton's husband served as a U.S. diplomat. Knowing fevers are one way the body combats infection, Whitton took him to local doctors who treated him for his fever and pink eye.
But Avery (pictured with his mother) grew sicker.
Over the course of six weeks, his headaches and body aches worsened and his fever continued to spike. When Avery woke at night crying from pain behind his eyes, Whitton became alarmed.
For the next five months, she took him to specialists from China to Singapore. He endured several tests and rounds of topical steroids. But after each round, the painful eye inflammation returned, and no one knew why. Then, new symptoms appeared.
"When he began hobbling from excruciating back pain, I thought, where in the world can we find someone who has the answer," said Whitton.
Light at the End of the Tunnel
Desperate and frightened, Whitton did her own research using the internet.The name that kept popping up was Moran Eye Center uveitis specialist Albert T. Vitale, MD (pictured at right).
"I thought, if anyone can find the answer, he can," said Whitton.
She cried during Avery's first appointment with Vitale, when the doctor told her they would find an answer.
After an extensive workup, we suspected Avery had tubulointerstitial nephritis with ocular uveitis syndrome (TINU)," said Vitale. "It's an uncommon cause of intraocular inflammation in association with systemic disease with only 250 cases reported in the literature."
In TINU, the body acts like it is rejecting a bad kidney transplant. Often, it is a short-term disorder. In rare cases, it may cause permanent kidney damage. Pediatric nephrology specialist Raoul Nelson, MD, PhD, at Primary Children's, biopsied Avery's kidney and confirmed TINU.
Getting Back to Normal
During treatment, Avery has been challenged by steroids that make him ‘wider,' by medication schedules that sometimes rob him of dessert, and by not being able to play soccer. But his prognosis is hopeful. Just days before his 11th birthday, Avery heard good news: "There is no inflammation, and his vision function is excellent. He can be as active as he wants to be," said Vitale.
One year later, "Avery's eyes are doing great," said his mom. "There continues to be some swelling of the optic nerve that never completely went away, but that could just be his new normal. His vision is great. They also continue to monitor his kidneys."
Avery (pictured at left) is now active playing soccer, he is on a top quiz tournament team, active in the Robotics Club, is the troop leader in scouts, and has just started to play the trombone in the school band. He plans to celebrate his 12th birthday by taking a group of friends to see the new Star Wars movie.
Uveitis is more than 30 separate disease entities with different clinical features, course and prognoses, and disease-specific indications for treatment. Inflammation can be confined to the eye or be systemic, and treatmentmust be individualized to each patient.
Moran uveitis specialists Albert T. Vitale, MD, Akbar Shakoor, MD, and Marissa Larochelle, MD, collaborate closely with the University of Utah's Divisions of Rheumatology (adult and pediatric), Infectious Diseases, and Huntsman Cancer Institute to provide complete care.