Uveo-Meningitis and Myelodysplastic Syndrome

Uveo-meningeal syndromes are any disorder characterized by the involvement of the uvea and the meninges. They can have multiple causes, including infectious, autoimmune and malignant diseases. We report the case of a patient with a 10-year-old diagnosis of myelodysplastic syndrome that had been stable. He presented with new onset uveitis, ataxia, diplopia and fluctuating consciousness level, without any obvious cause revealed by brain imaging or blood chemistries. An extensive aetiological search showed no obvious cause. Initially, the patient improved spontaneously and was discharged. However, 2 months later, he deteriorated once again, this time with disperse adenomegalies that were not present previously. The bone marrow biopsy showed a high number of blasts, which affirmed the progression of the previously known myelodysplastic syndrome. The lymph nodes were not biopsied due to very low life expectancy, making the procedure futile. A presumptive diagnosis of uveo-meningitis caused by paraneoplastic syndrome was made. The patient died a few months later. LEARNING POINTS: Uveo-meningeal syndrome (UMS) is a rare entity usually of infectious or inflammatory aetiology. UMS may be caused by some neoplastic disorders, mainly lymphoma and metastasis of solid tumours; myelodysplastic syndrome (MDS) has not been previously implicated. Diagnosis should include lumbar puncture and a thorough search for the aetiology; treatment is directed towards the aetiology.