ABO Uveitis 2 — Questions and Answers
Question 1: Which presentation is most characteristic of HLA-B27-associated anterior uveitis?
- Bilateral chronic granulomatous iritis with mutton-fat keratic precipitates
- Acute unilateral, recurrent, often alternating nongranulomatous iritis with fibrin (Correct answer)
- Painless chronic iridocyclitis with stellate keratic precipitates and iris heterochromia
- Bilateral posterior uveitis with serous retinal detachments
Correct answer: Acute unilateral, recurrent, often alternating nongranulomatous iritis with fibrin
HLA-B27 uveitis classically presents as sudden unilateral, alternating, recurrent anterior uveitis, often with fibrin or hypopyon.
Question 2: Large greasy 'mutton-fat' keratic precipitates with Busacca nodules most strongly suggest which etiology?
- Ankylosing spondylitis
- Fuchs uveitis syndrome
- Sarcoidosis (Correct answer)
- Posner-Schlossman syndrome
Correct answer: Sarcoidosis
Mutton-fat KPs and iris nodules indicate granulomatous inflammation, classically sarcoidosis.
Question 3: A 35-year-old has unilateral chronic low-grade iritis, diffuse stellate keratic precipitates, iris heterochromia, and no posterior synechiae. Which virus is most associated with this condition?
- Rubella virus (Correct answer)
- Herpes simplex virus
- Epstein-Barr virus
- Varicella-zoster virus
Correct answer: Rubella virus
Fuchs uveitis syndrome is strongly linked to intraocular rubella virus, with CMV implicated in some cases.
Question 4: A patient has recurrent unilateral episodes of markedly elevated IOP (50 mmHg) with mild anterior chamber reaction and few fine keratic precipitates. Aqueous PCR is most likely to show which pathogen?
- Toxoplasma gondii
- Cytomegalovirus (Correct answer)
- Treponema pallidum
- Mycobacterium tuberculosis
Correct answer: Cytomegalovirus
Posner-Schlossman (glaucomatocyclitic crisis) is frequently associated with CMV in immunocompetent patients.
Question 5: Which child with juvenile idiopathic arthritis has the highest risk of developing uveitis?
- 10-year-old ANA-negative boy with systemic-onset JIA
- 4-year-old ANA-positive girl with oligoarticular JIA diagnosed 1 year ago (Correct answer)
- 12-year-old RF-positive girl with polyarticular JIA
- 8-year-old HLA-B27-positive boy with enthesitis-related arthritis
Correct answer: 4-year-old ANA-positive girl with oligoarticular JIA diagnosed 1 year ago
Young age at onset, oligoarticular disease, ANA positivity, and short disease duration carry the highest risk of asymptomatic chronic anterior uveitis.
Question 6: A young man of Turkish descent has recurrent oral aphthae, genital ulcers, a shifting hypopyon, and occlusive retinal vasculitis. Which therapy is most appropriate for sight-threatening disease?
- Topical corticosteroids alone
- Oral acyclovir
- Anti-TNF therapy such as infliximab or adalimumab (Correct answer)
- Observation, since disease is self-limited
Correct answer: Anti-TNF therapy such as infliximab or adalimumab
Behçet posterior segment disease is sight-threatening and anti-TNF agents are effective first-line options for severe involvement.
Question 7: An adolescent girl has bilateral anterior uveitis and recent fatigue, weight loss, and elevated serum creatinine. Which test best supports the suspected diagnosis?
- Serum angiotensin-converting enzyme
- HLA-A29 typing
- Urinary beta-2 microglobulin (Correct answer)
- Anti-cyclic citrullinated peptide antibody
Correct answer: Urinary beta-2 microglobulin
Elevated urinary beta-2 microglobulin supports tubulointerstitial nephritis and uveitis (TINU) syndrome.
ABO Uveitis 2
Which presentation is most characteristic of HLA-B27-associated anterior uveitis?