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.