•• MARCH 2001 ••

DAY 1: After eating a meal consisting of chicken parmigiana, patient develops urticaria involving the left leg and right cheek. Within 1 week, hives appear in these areas.

DAY 2: The patient notes a subcutaneous lump in her right cheek, which subsequently extends to the right lateral canthus. Next, edema of the upper and lower right eyelids develop, with concomitant stomach ailments and decreased appetite. She is examined by an internist and given omeprazole, oral iron supplements, oral penicillin, and aspirin. A blood workup reveals the presence of anemia and H. pylori infection. The patient is given Prevpack for 2 weeks, after which she shows signs of improvement.

A FEW WEEKS LATER: The subcutaneous lump resolves but reappears within 2 to 3 weeks, after the patient ingests undercooked pork. This event is accompanied by headaches and more severe swelling of the eyelids. The patient’s condition is diagnosed as an eyelid infection and allergic rhinitis. The patient is given clarithromycin, which she takes voluntarily for only 2 or 3 days. The lump subsides, as do the headaches.

•• JULY 2001 ••

Three months later, the patient experiences pain in the kidney region. Cystitis is diagnosed and nitrofurantoin prescribed. An allergic disease is also diagnosed, for which cetirizine (Zyrtec) is prescribed.

•• AUGUST 2001 ••

Patient reports itchy, red right eye, which is attributed to contact lens use. She is treated for conjunctivitis with Tobrex. However, the symptoms worsen and itching is now associatedwith pain. Her internist makes a diagnosis of glaucoma, for which he prescribes pilocarpine 2% in addition to Vicodin for the pain.

1 WEEK LATER: The internist gives the patient levofloxacin, prednisone 40 mg qd, and cefazolin and refers the patient to an ophthalmologist for suspected uveitis.

•• SEPTEMBER 2001 ••

The ophthalmologist makes a diagnosis of uveitis and treats the patient with topical steroids and cycloplegics. The patient does not respond to treatment, despite continued therapy with oral prednisone 40 mg qd. She reports a gradual but significant decrease in vision, associated with more frequent and more severe headaches. The patient arrived at our institute with these symptoms.