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Background  Tubulointerstitial nephritis and uveitis syndrome is a rare lymphocyte-related oculorenal inflammatory disease presumed to be associated with drug use and infectious agents.  Toxoplasma gondii  is one of such pathogens that could exhibit encephalitis, meningitis, and uveitis in immunocompromised or in some immunocompetent individuals. If the immunoglobulin M of  Toxoplasma  is positive on screening, the interpretation of the result is not simple, especially when immunoglobulin M stays positive persistently.    Case presentation  A 34-year-old Asian male developed fever, headache, and lymphadenopathy with tenderness, which was initially diagnosed as meningitis. Antibiotics were started, and diclofenac sodium was used for the fever. Although his symptoms were alleviated in a week by the treatment, gradual decline in renal function was noted, prompting a renal biopsy that indicated acute granulomatous interstitial nephritis. A week later, tenderness in both eyes with blurred vision appeared and revealed iritis and keratic precipitations in both eyes; hence, the diagnosis of acute tubulointerstitial nephritis and bilateral uveitis syndrome was made.  Toxoplasma gondii -specific immunoglobulin G and immunoglobulin M titers were both positive. Although we could not rule out recent infection of  Toxoplasma gondii , which may cause uveitis initially,  Toxoplasma  immunoglobulin G avidity test indicated a distant infection, which allowed us to rule out meningitis and uveitis as responsible for the complication of recent  Toxoplasma gondii  infection. Drug-induced lymphocyte stimulation test, or lymphocyte transformation test of diclofenac sodium, was solely positive among the tested drugs. Uveitis was alleviated only with ophthalmic steroid, and renal function returned to normal without administration of systemic steroid.    Conclusions  We experienced a case of diclofenac-induced tubulointerstitial nephritis and uveitis syndrome. In ruling out infections,  Toxoplasma  immunoglobulin M was persistently positive, and  Toxoplasma  immunoglobulin G avidity test indicated a “distant” infection. From these two results, we ruled out recent infection. However, it should be noted that “distant” infection indicated by commercial immunoglobulin G avidity is still a multiplex profile consisting of reinfection, reactivation, and latent infection. Narrowing down the infection profile of  Toxoplasma  is challenging in some cases. Therefore, careful diagnosis and extended follow-up of such patients are needed.

journal of medical case reports

Tubulointerstitial nephritis and uveitis syndrome following meningitis and systemic lymphadenopathy with persistent Toxoplasma immunoglobulin M: a case report