Azimi Ali, Shirvani Mohammad, Hosseini Shahla, Bazojoo Vahid, Masihpoor Nasrin, Mohaghegh Sahar, Sadeghi Seyed Mohammad
Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Infectious Ophthalmologic Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
J Ophthalmic Inflamm Infect. 2020 Aug 27;10(1):18. doi: 10.1186/s12348-020-00210-6.
Anterior uveitis (AU) is the most common form of uveitis. The differential diagnosis of AU is broad, ranging from infectious etiologies to autoimmune causes. However, approximately half remain idiopathic. Infections are the vision-threatening causes of AU which should be ruled out by history taking and detailed physical examination combined with guided work up. We report a rare case of bilateral granulomatous AU following hepatitis A virus (HAV) infection in an immunocompetent patient. A 35-year-old male presented to our center with a chief complaint of pain and redness in both eyes 3 days prior to the presentation. The patient's medical and drug history was unremarkable. He had a history of river water consumption 20 days prior to presentation. The patient was diagnosed with acute bilateral granulomatous AU. All routine work up to investigate the etiology of the disease was unremarkable, except for the serology of acute HAV infection, which was positive. The patient was managed with the topical steroid and cycloplegic for 2 weeks with no recurrence at one-year follow up. Extra-hepatic complications of HAV were reported in previous studies including arthritis, urticaria, myocarditis, nephritis, and myositis. The mechanism of extra-hepatic complication of hepatitis A is unknown; however, immune-complex deposition is most likely the etiological cause. Our report represents a rare case of sudden onset with limited duration granulomatous AU as a presenting manifestation of HAV infection. Previous studies do not provide a direct evidence of granulomatous AU associated with the HAV infection.
前葡萄膜炎（AU）是葡萄膜炎最常见的形式。AU的鉴别诊断范围广泛，从感染性病因到自身免疫性病因。然而，约半数病例仍病因不明。感染是威胁视力的AU病因，应通过病史采集、详细体格检查并结合针对性检查予以排除。我们报告一例免疫功能正常患者在感染甲型肝炎病毒（HAV）后发生双侧肉芽肿性AU的罕见病例。一名35岁男性因双眼疼痛和发红3天前来我院就诊。患者的病史和用药史无异常。发病前20天有饮用河水史。该患者被诊断为急性双侧肉芽肿性AU。除急性HAV感染血清学检查呈阳性外，所有用于调查病因的常规检查均无异常。患者接受局部类固醇和睫状肌麻痹剂治疗2周，随访一年无复发。既往研究报道了HAV的肝外并发症，包括关节炎、荨麻疹、心肌炎、肾炎和肌炎。甲型肝炎肝外并发症的机制尚不清楚；然而，免疫复合物沉积很可能是病因。我们的报告呈现了一例罕见病例，即肉芽肿性AU作为HAV感染的表现突然起病且病程有限。既往研究未提供与HAV感染相关的肉芽肿性AU的直接证据。
