Hypertensive uveitis: an initial presentation for primary antiphospholipid syndrome

Abstract

The authors aim to report a case of hypertensive uveitis-associated primary antiphospholipid antibody syndrome (APS). A 25-year-old woman presented with unilateral painless diminution of vision. Examination revealed right chronic anterior uveitis, complicated cataract, and appositional angle-closure glaucoma uncontrolled with medications, for which sequential phacoemulsification–trabeculectomy was performed. Rheumatological consultation revealed the diagnosis of primary APS according to revised Sapporo criteria. Accordingly, systemic steroids and hydroxychloroquine were prescribed. The patient experienced an attack of posterior uveitis 2 years later, which necessitated a maintenance dose of an immunomodulator. Following systemic treatment and intravitreal triamcinolone, the patient’s vision improved from hand motion good projection to 0.3 with no inflammation 8 months following the last relapse. We conclude that hypertensive uveitis can be a presenting feature of primary APS. Antiphospholipid laboratory profile could be added to the workup of uveitis whenever clinical suspicion is present. Thromboprophylaxis could be added when antiphospholipid is positive.

Keywords

• hypertensive uveitis
• immunomodulators
• primary antiphospholipid syndrome
• sapporo criteria
• thromboprophylaxis