A Case of Iritis in a Boy of 13

Introduction

 I started seeing this male child in 23.07.14, when he was 13 years old. His mother came in desperation because the child was diagnosed with a very complicated case of iritis and several specialists (Portugal and Spain), told her he would shortly end up blind, probably before he reached university age.

ABOUT THE DISEASE – IRITIS

Iritis is an inflammatory condition of the colored portion of the eye (iris). It causes varying degrees of redness of the eye, often with significant pain, sensitivity to light, tearing, and blurred vision. Officially it is called anterior uveitis. The uvea is the collective name for the pigmented portions of the internal eye and includes the iris, the ciliary body and the choroid. When an inflammation affects primarily the iris and ciliary body it is often called iritis. The pupil is the opening in the iris through which light passes. In addition, the pupil of the affected eye may be smaller than that of the healthy eye.

CHIEF COMPLAINTS

When he was 10 years old started having headaches and complained about the right eye; it was painful and the vision was altered. Frequently the pains were accompanied by vomiting. They went first to the GP and afterwards to the first specialist in Portugal and afterwards, as the boy continued getting worse, they tried other specialists in Portugal and in Spain. They prescribed several kinds of drops with antibiotics, antihistamines, antivirals, antifungals and cortisone. Nothing worked and he was going from bad to worse. He had a lot of pains, couldn’t go to school and felt very exhausted. The eye was red, and very swollen, almost closed. He could not stand any light and could not even go out of the house. Now he had nausea frequently with the pains but he would not vomit. Meanwhile the symptoms started also to appear in the left eye. After some time tests were conducted, as doctors thought it could be a brain tumor. The tests came back negative. So at that point they started giving cortisone injections. He would feel better for a short while but then the symptoms returned. On Feb 13 he was started on methotrexate. He was very swollen and flabby all over because of cortisone.  He was taking 8 tablets of methotrexate every weekend and 10 mg of cortisone every day, and in the crisis he takes naproxen (NSAID), 250mg. Even with all this medication he was having a crisis every week.

Generals:

Doesn’t like sweets and likes bread and butter

OTHER SYMPTOMS

Salivation during sleep

Hypermetropia (13), strabismus (surgery on the left) and recurrent tonsillitis.

PAST HISTORY

As a young child beside the vision problems he had recurrent otitis and bronchiolitis. He took a lot of antibiotics and cortisone.

FAMILY HISTORY

Father’s side: cancer. Mother’s side: cardiovascular problems in early years.

ANALYSIS

After doing anamnesis I chose the following rubrics:

REMEDY PRESCRIBED

Mercurius solubilis 30 C every day

At the same time:

• stop MTX
• Reduce oral cortisone in just 2.5mg/ day every week

I asked the mother to call me if any crisis would arrive and I booked a follow-up after 1 month.

FOLLOW-UP   28.08.14 (after 1 month)

The child is better, no crisis during this month. Not using MTX since 1 month, and just taking 2.5mg of cortisone a day now.  Mother told me during the previous month that he is having perspiration in the night, whole body with some odor.

REMEDY PRESCRIBED

Mercurius solubilis 30 C every day

At the same time:

• Reduce oral cortisone, taking 2.5mg every other day, first week and then every two days another week and so on.

I asked the mother to call me if any crisis would occur.

FOLLOW-UP   28.12.14  (after 4 months)

The child is not taking cortisone for 2 months and is much better in general. He lost a lot of weight and didn’t have any crisis during this time. One month ago the mother called me because he started having symptoms of tonsillitis. As he was not taking cortisone anymore and was still taking the Mercurius sol. every day, I told her to stop the Mercurius, and the symptoms subsided. One week ago he had an infection with pus in an ingrowing toe nail and couldn’t stand to have shoes on and even walking was very painful. I told the mother by phone to give Hepar Sulphur 30 repeatedly. The foot got better but the eyes started hurting. Because of that the mother started giving 250mg of naproxen every day before coming to consultation. Te boy is also worried about the exams at school. The salivation during sleep is much less; he is feeling very cold in general and is perspiring from the feet with offensive odor. I noticed too, that he had white spots in his finger nails.

REMEDY PRESCRIBED

Silicea 30 C every day and stop the Naproxen immediately. Contact me by phone if needed.

After 3 days he didn’t have any pain in the eyes.

FOLLOW-UP   03.12.17

In these 3 years I didn’t hear anything from this family. Now they booked an appointment for me to see the boy because he is going to university abroad. His mother wanted me to see him just to advise what remedies he should take with him in case he needs something. He has been fine and I told him if he needs anything we could skype. I gave him a list of remedies to take if needed.