More than meets the eye

Clinical presentation

A 74-year-old woman was admitted to the ophthalmology department with progressive vision loss, vitreous clouding and suspected endogenous endophthalmitis. Bilateral eye problems had started several weeks before and grew worse under oral prednisolon therapy. After admission, progressive vitreous haze was diagnosed (figure 1A). A diagnostic vitrectomy was performed for microbiological testing.

The patient was also presented with watery diarrhoea that had started 6 months ago. Bowel movements were independent of food ingestion and occurred also during the night; furthermore, the patient reported weight loss of 6–7 kg, epigastric pain, latent nausea and deterioration of general well-being. An incomplete gastroenterological assessment had been performed elsewhere, including microbiological testing of stool samples, blood tests, chest X-ray, abdominal CT and colonoscopy without intubation of the terminal ileum. Apart from microcytic anaemia (haemoglobin level=8.2 g/L; mean corpuscular volume=76.0 fl), there had been no pathological findings.

Over the last 20 years, the patient had...

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