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Uncommon presentation of eye involvement in juvenile psoriatic arthritis relapse
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  1. Serena Pastore1,
  2. Cristina Tumminelli2,
  3. Francesca Burlo2 and
  4. Alberto Tommasini1,3
  1. 1Department of Paediatrics, Burlo Garofalo Pediatric Institute, Trieste, Friuli Venezia Giulia, Italy
  2. 2Clinical Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Friuli Venezia Giulia, Italy
  3. 3Università degli Studi di Trieste, Trieste, Friuli-Venezia Giulia, Italy
  1. Correspondence to Dr Serena Pastore; serena.pastore{at}burlo.trieste.it

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Description

A girl in her teens presented to our rheumatology service for a bruising eye, with sudden onset of whitish layer in front part of the left eye (figure 1). She was cared for ANA-positive and HLAB27-positive psoriatic arthritis associated with recurrent iridocyclitis. Two days before, despite immunosuppressive treatment with adalimumab, she had presented a relapse of iridocyclitis in the left eye, therefore, a treatment with oral corticosteroids and mydriatic drops had been started.

Figure 1

Hypopyon visible as a white horizontal streak in the anterior chamber of the left eye, due to the deposition of a thin layer of white blood cells.

At the visit, a hypopyon was evident and the slit-lamp examination showed cells 4+, Tyndall 2+. Thus, the treatment was intensified with an intravenous bolus of methylprednisolone (5 mg/kg), carrying on oral corticosteroid therapy. After 1 week, her conditions consistently improved and the steroid therapy was gradually decreased.

Hypopyon is an inflammatory condition characterised by an exudate rich in white blood cells in the anterior chamber of the eye. It has diagnostic value, because it tends to occur in association with specific conditions rather than as a general ocular inflammation.1 This condition has been rarely described in children, and it has been reported in a few cases of juvenile idiopathic arthritis with uveitis.2 3 HLAB27 is considered a risk factor for hypopyon in patients with iridocyclitis. Fortunately, hypopyon does not appear to be associated with poor ophthalmological outcomes.3 This case highlights that children with iridocyclitis require a close follow-up and that urgent clinical evaluation is needed in the presence of symptomatic iridocyclitis to allow effective treatment with high-dose glucocorticoids.

Learning points

  • Systemic corticosteroid therapy should be considered whenever there is no response to topical treatment.

  • Hypopyon uveitis could be an ophthalmic finding associated with psoriasic arthritis.

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References

Footnotes

  • Contributors CT and FB wrote the first draft of this article. SP and AT reviewed the article before submission.

  • Funding This study was funded by Ministero della Salute (RC 23/2022).

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.