Korean J Ophthalmol.  2012 Aug;26(4):309-311. 10.3341/kjo.2012.26.4.309.

Recurrent Bilateral Retinal Vasculitis as a Manifestation of Post-streptococcal Uveitis Syndrome

• Han J
• Lee SC
• Song WK

• KMID: 1387401
• DOI: http://doi.org/10.3341/kjo.2012.26.4.309

Abstract

We report a case of post-streptococcal uveitis mainly presenting with bilateral recurrent retinal vasculitis in Korea. A 14-year-old Asian female presented with decreased visual acuity of 20 / 30 in the right eye and 20 / 25 in the left eye. The patient had a history of glomerulonephritis nine months before onset of uveitis. The manifestation of uveitis was predominantly retinal vasculitis. We presumed post-streptococcal uveitis because probable streptococcal infection was confirmed by anti-streptolysin O titer elevation. With topical and oral steroid treatments, the patient experienced complete vision recovery. Post-streptococcal uveitis occurs rarely and mostly involves young patients in the form of non-granulomatous anterior uveitis. However, as this case shows, it may primarily involve the posterior uvea without anterior inflammation and may recur.

Keyword

Antistreptolysin; Streptococcus; Uveitis; Vasculitis

MeSH Terms

Adolescent
Diagnosis, Differential
Female
Humans
Recurrence
Retinal Vasculitis/drug therapy/*microbiology
Steroids/therapeutic use
Streptococcal Infections/*diagnosis
Uveitis/drug therapy/*microbiology
Visual Acuity

Figure

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  Fig. 1 Colored fundus photograph of the right eye (A) and the left eye (B), demonstrating a blurred disc margin with swelling. Fluorescein angiography of the right eye (C) and the left eye (D) showing vascular leakage at the late phase.

Reference

1. Reddy UP, Albini TA, Banta JT, Davis JL. Post-streptococcal vasculitis. Ocul Immunol Inflamm. 2008. 16:35–36.

2. Cokingtin CD, Han DP. Bilateral nongranulomatous uveitis and a poststreptococcal syndrome. Am J Ophthalmol. 1991. 112:595–596.

3. Wirostko WJ, Connor TB Jr, Wagner PF. Recurrent post-streptococcal uveitis. Arch Ophthalmol. 1999. 117:1649–1650.

4. Ur Rehman S, Anand S, Reddy A, et al. Poststreptococcal syndrome uveitis: a descriptive case series and literature review. Ophthalmology. 2006. 113:701–706.

5. Gallagher MJ, Muqit MM, Jones D, Gavin M. Post-streptococcal uveitis. Acta Ophthalmol Scand. 2006. 84:424–428.

6. De Smet MD. Papillophlebitis and uveitis as a manifestation of post-streptococcal uveitis syndrome. Eye (Lond). 2009. 23:985–987.

7. Fox A, Hammer ME, Lill P, et al. Experimental uveitis. Elicited by peptidoglycan-polysaccharide complexes, lipopolysaccharide, and muramyl dipeptide. Arch Ophthalmol. 1984. 102:1063–1067.

8. Wells A, Pararajasegaram G, Baldwin M, et al. Uveitis and arthritis induced by systemic injection of streptococcal cell walls. Invest Ophthalmol Vis Sci. 1986. 27:921–925.

9. Feldon M, Dorfman L, Tauber T, et al. Post-streptococcal glomerulonephritis and uveitis: a case report. Pediatr Nephrol. 2010. 25:2351–2353.