title: [Management of uveomeningitis in internal medicine: Proposal for a diagnostic work-up].
abstract: Uveomeningitis relates to an inflammatory state extending from iris and ciliary bodies to the choroid behind the eye. Because of a close contact between eye and brain, and barrier disruption, the inflammation can spread into the central nervous system (CNS). We review the clinical manifestations of uveitis, which are known to provide helpful clues to the diagnosis and describe the infectious, inflammatory, and neoplastic conditions classically associated with the uveomeningitis. Inflammatory or auto-immune diseases are probably the most common clinically recognized causes of uveomeningitis associated with a significant pleiocytosis. These entities often cause inflammation of various tissues in the body, including ocular structures and the meninges (i.e., sarcoidosis, Behçet's disease, and Vogt-Koyanagi-Harada syndrome). The association of an infectious uveitis with an acute or a chronic meningo-encephalitis is unusual but occasionally the eye examination may suggest an infectious etiology or even a specific organism responsible for an uveomeningitis. One should consider the diagnosis of primary ocular-CNS lymphoma in patients of 40 years of age or older with bilateral uveitis, especially with prominent vitritis, showing poor response to corticosteroid therapy. Finally, an algorithm for the diagnostic approach of uveomeningitis is proposed.
authors.affiliation: Service de médecine interne, hôpital Avicenne, AP-HP, université Paris 13, Sorbonne Paris Cité, 93009 Bobigny cedex, France. Electronic address: sebastien.abad@aphp.fr.
authors.forename: S
authors.initials: S
authors.lastname: Abad
authors.affiliation: Service d'ophtalmologie, GH Saint-Louis-Lariboisière-Fernand-Widal, centre Roule-Péretti, hôpital Lariboisière, AP-HP, 169, avenue Achille-Péretti, 92200 Neuilly-sur-Seine, France.
authors.forename: C
authors.initials: C
authors.lastname: Terrada
authors.affiliation: Service de médecine interne, hôpital Ambroise-Paré, AP-HP, université de Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
authors.forename: S
authors.initials: S
authors.lastname: Trad
authors.affiliation: Service de médecine interne, GH Saint-Louis-Lariboisière-Fernand-Widal, hôpital Lariboisère, AP-HP, université Sorbonne Paris Cité Paris Diderot, 75475 Paris cedex 10, France.
authors.forename: D
authors.initials: D
authors.lastname: Sène
authors.affiliation: Service de médecine interne, hôpital du Bocage, 21079 Dijon cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Bielefeld
authors.affiliation: Service de médecine interne, DHU I2B, inflammation, immunopathology, biotherapy, Centre national de référence des maladies auto-immunes et systémiques rares, hôpital Pitié-Salpêtrière, AP-HP, université Pierre-et-Marie-Curie - Paris 6, 75013 Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Saadoun
authors.affiliation: Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, université de Lyon, 69317 Lyon cedex 04, France.
authors.forename: P
authors.initials: P
authors.lastname: Sève
mesh_terms: D000465:Algorithms; D003937:Diagnosis, Differential; D015817:Eye Infections / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D008581:Meningitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D017410:Practice Guidelines as Topic; D012507:Sarcoidosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D014605:Uveitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D014607:Uveomeningoencephalitic Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*
keywords: Behçet's disease; Diagnostic procedure; Démarche diagnostique; Maladie de Behçet; Maladie de Vogt-Koyanagi-Harada; Sarcoidosis; Sarcoïdose; Uveomeningeal syndromes; Uvéoméningites; Vogt-Koyanagi-Harada disease