Recurrent unilateral anterior uveitis in an HLA-B27-positive ankylosing spondylitis patient: varicella-zoster virus etiology case report.

BACKGROUND

A 28-year-old Chinese woman with human leukocyte antigen (HLA)-B27-positive ankylosing spondylitis (AS) for 5 years experienced recurrent left-eye blurred vision and redness for 4 years (2-3 episodes/year). This was previously attributed to AS without etiologic testing. Her father and brother had AS but without ocular involvement. The patient received no systemic disease-modifying therapy for AS throughout her clinical course.

METHODS

Ophthalmic examinations [visual acuity, intraocular pressure (IOP), slit-lamp, and dilated fundus] and 100-µL left-eye aqueous humor testing [via paracentesis: varicella-zoster virus (VZV) immunoglobulin G (IgG), Goldmann-Witmer coefficient (GWC), and herpes simplex virus (HSV)-1/2/cytomegalovirus (CMV) antibodies/DNA] were performed. Targeted stepwise topical anti-inflammatory and IOP-lowering regimens were administered.

RESULTS

For the left eye, the following were observed: 20/30 visual acuity, 36-mmHg IOP, mutton fat keratic precipitates (KP), and iris atrophy. Findings for the right eye: were normal. Aqueous testing revealed elevated VZV IgG (1,227.02 U/mL) and a positive GWC (114.03), whereas HSV/CMV markers were negative. After treatment, visual acuity in the left eye improved to 20/20, IOP normalized, and symptoms resolved. No corneal sensation assessment was performed at any visit, and the patient denied any subjective corneal sensory discomfort during follow-up.

CONCLUSION

Defaulting to AS-related uveitis in HLA-B27-positive patients should be avoided, and aqueous testing is recommended because it enables targeted management. Clinicians should adopt rational, stepped topical hypotensive combination therapy.