A 58-year-old male with a history of CAD, HTN, atrial fibrillation, and schizophrenia presented with 2 days of decreased vision, redness, and pain in the right eye. There was no trauma. Visual acuity was CF OD and IOP OD was elevated. Exam revealed a hemorrhagic hypopyon and fibrin membrane. There was no vitritis on ultrasound. He was treated initially for HSV keratouveitis. Two days later, he was empirically treated for acute anterior uveitis (AAU) with topical corticosteroids and cycloplegic. Lab testing was subsequently positive for HLA-B27. Lumbar plain films consistent with ankylosing spondylitis. Further testing revealed optic nerve edema in the affected eye. Hemorrhagic hypopyon is a rare presentation of HLA-B27-associated uveitis that has not been previously reported in the literature. Fortunately, the patient’s vision recovered to baseline and optic nerve swelling resolved with topical treatment. He will be monitored closely by ophthalmology and rheumatology.
Presentation Date: 08/22/2019
Issue Date: 08/01/2020