Observation
We report the case of a 61-year-old man, non-smoker, with a 5-year
history of diabetes mellitus type 2, treated with Metformine and basal
insulin, who presented with recurrent eye redness, ocular pain and
progressive decrease in visual acuity of the left eye. Ocular symptoms
were evolving for six months and were associated with clinical
deterioration with a significant weight loss of 30 kilos in six months.
Physical examination was normal. The patient was afebrile with normal
vital signs. There were no general symptoms, meningeal syndrome or
cutaneous eruption. All biological parameters were normal.
Ophtalmological examination showed decreased visual acuity with 8/10
vision on the right eye and 3/10 vision on the left. There were features
of non-granulomatous panuveitis: left anterior uveitis with hypopion,
posterior iris synechia and dense diffuse vitritis without retinal
detachment. The right eye was quiet, with no evidence of intra-ocular
inflammation.
Orbital ultrasonography showed circumferential left choroidal echogenic
and heterogeneous tissular thickening suggestive of metastases.
Thoraco-abdominopelvic computed tomography was performed in order to
search primitive neoplasm. An invasive heterogeneous tumor mass at the
level of the pancreatic body measuring 48*36 mm, with upstream
pancreatic atrophy and a marked dilatation of the Wirsung duct was
detected (figure 1). Multiple nodules disseminated through liver
parenchyma, spontaneously hypodense without bile duct dilatation were
also noted.