S4975 In the Blink of an Eye: An Uncommon IBD Extra-Intestinal Manifestation of Panuveitis

Introduction: Extraintestinal manifestations (EIMs) frequently occur in inflammatory bowel disease (IBD). Ocular involvement is the third most common EIMs and can occur independently from intestinal inflammation. Uveitis refers to inflammation of any part within the uvea, which includes the iris, ciliary body, and choroid. Panuveitis, a rare EIM, is diffuse inflammation of all parts of the uvea that can also involve the retina secondarily. The management of panuveitis is complex, requiring a multi-disciplinary approach and close monitoring. We present a case of panuveitis secondary to inflammatory bowel disease, highlighting an uncommon and difficult to treat EIM. Case Description/Methods: A 21-year-old man presented with hematochezia and was found to have pan colonic erythema and ulcerations on endoscopy. Histology demonstrated active chronic colitis with cryptitis/crypt abscesses; collectively concerning for inflammatory colonic Crohn’s disease. The patient’s symptoms improved on steroids and vedolizumab induction. The patient was tapered off steroids and 5 months later he presented to the emergency department with blurry vision of the right eye. Ophthalmologic evaluation was consistent with acute iritis with treatment including topical steroids every hour and twice daily atropine drops. On subsequent follow ups, the patient continued to have inflammation and eventually developed involvement of the optic nerve concerning for panuveitis. Oral steroids were restarted, and the patient was transitioned to infliximab infusions. A repeat colonoscopy showed diffuse colitis with deep ulcerations of segmental involvement. Subsequently he was referred to a retinal specialist with recommendation to start methotrexate. The patient reached clinical remission in the setting of infliximab infusions, methotrexate, azathioprine and oral steroids. His ophthalmologic exam improved to baseline with a plan to taper off steroids and methotrexate. Discussion: EIMs occur in approximately 25%-40% of IBD patients and can affect the joints, skin, eyes and liver to name a few. Ocular involvement is most commonly episcleritis or anterior uveitis which are treated with topical medications. Panuveitis is a rare EIM and treatment often requires additional systemic immunosuppressive agents as well as oral corticosteroids. This case highlights the importance of a comprehensive evaluation of any ocular complaints in patients with IBD and escalating immunosuppression in more severe cases of ocular EIMs.