HLA-B27 positive juvenile idiopathic arthritis associated uveitis presenting with an acute onset and a chronic course

Purpose: The occurrence of Human leukocyte antigen-(HLA-) B27-associated bilateral granulomatous panuveitis in a pediatric patient ultimately diagnosed with oligoarticular juvenile idiopathic arthritis JIA. Case Presentation: A 10-year-old girl was evaluated for redness, pain, and photophobia in both eyes (OU) with no other ocular or systemic symptoms. Her best-corrected visual acuity was measured at 20/20 and 20/40 right (OD) and 20/40 left (OS) eyes, respectively. A slit lamp examination revealed mutton-fat keratic precipitates OU, anterior chamber reaction 1+ and 4+ cells OD and OS, respectively, and anterior vitreous 2+ cells OU. During dilated fundoscopy, 1+ OS haze was observed. Intravenous fluorescein angiography depicted mild disc OS and peripheral vascular leakage OU. Indocyanine green angiography revealed hypocyanescent lesions in choroid OU indicating of choroiditis. All lab work-up were negative or within the normal limits except positive HLA-B27. She was started on aggressive corticosteroids therapy, followed by a gradual taper. A flare-up occurred while she was on a regimen of 10 mg oral prednisolone and two drops of prednisolone OU. Then, immunomodulatory therapy was initiated with adalimumab and oral methotrexate. The eyes remained in remission with this regimen until she developed arthritis in the left knee and wrist, along with bilateral sacroiliitis. The pediatric rheumatology team decided to transition to golimumab, concurrently increasing the dosage of methotrexate. Conclusion: Chronic bilateral panuveitis with an acute onset granulomatous anterior uveitis component may be indicative of HLA-B27 associated JIA. It can be coupled with a delayed onset oligoarticular JIA.