This retrospective study on the etiology and outcome of patients with simultaneous-onset nongranulomatous bilateral acute anterior uveitis (BAAU) found that the disease is rare, more common in younger patients and most frequently associated with recent infection and/or systemic antibiotic use. The authors recommend that tubulointerstitial nephritis and uveitis syndrome should also be considered as a diagnosis. Diagnostic evaluation should include serum antistreptolysin-O titers, HLA-B27 antigen and urine β2 microglobulin levels because these may reveal systemic disease that requires therapy.
They reviewed medical records of patients who presented to a single tertiary care center with simultaneous-onset nongranulomatous bilateral acute anterior uveitis between January 1990 and May 2010. Out of a total of 4,288 new patients with uveitis evaluated during this period, 44 (1 percent) presented with simultaneous-onset nongranulomatous BAAU. This group was younger than the entire cohort of new patients with uveitis who were evaluated during the same time period (P = 0.002).
The most common etiologies were post-infectious or drug-induced uveitis, seen in 23 of 44 patients (52 percent), and idiopathic uveitis, in 15 patients (34 percent). Tubulointerstitial nephritis and uveitis syndrome, HLA-B27-associated uveitis, inflammatory bowel disease and Kawasaki disease each made up fewer than 5 percent of diagnoses.
For 14 of the 15 patients with at least a year of follow-up (93 percent), disease duration was limited, at less than three months. Of these 14 patients, half of them developed recurrent disease, with an average time to first recurrence of 20 months (range, 7.5 to 40 months) after resolution of the initial inflammatory episode.
The authors note that simultaneous-onset nongranulomatous BAAU must be distinguished from the insidious onset of anterior uveitis seen in children with juvenile idiopathic arthritis. Obtaining a detailed and thorough history, including queries regarding recent infection and use of systemic antibiotics or nonsteroidal anti-inflammatory drugs, may help elucidate a diagnosis. A complete review of systems, specifically focusing on possible systemic infection, gastrointestinal dysfunction or signs of systemic vasculitis in a child, should be included. Diagnoses to consider include post-infectious or drug-induced uveitis and tubulointerstitial nephritis and uveitis syndrome.
They conclude that making an appropriate diagnosis is important in these young patients because each disease has its own set of associated systemic implications.