Abstract
A 13-year-old male patient presented with bilateral periocular oedema, photophobia, and blurred vision, preceded by a week-long episode of flu-like symptoms and accompanied by a persistent cough and skin rash. He was asthmatic on steroid inhalers.
He had bilateral upper lid erythema and oedema without tenderness. His visual acuity (VA) was 6/6 and 6/9 in the right and left eyes, respectively. Examination revealed bilateral acute anterior uveitis (AAU) characterized by +3 cells and flare. The left eye had fibrinous exudate without signs of synechiae. Anterior vitreous cells were present. Fundus examination was unremarkable.
He was admitted under the paediatric team for systemic investigations and was started on intense topical steroids as well as a cycloplegic. Full uveitis workup including ANA, ANCA, HLA-B27, serum ACE, Antistreptolysin-O titre, QuantiFERON, as well as serology for syphilis, were negative. His CRP was moderately elevated. Chest X-ray was normal. MRI orbit showed mildly enlarged lacrimal glands with signs suggestive of orbital inflammatory syndrome. He was started on tapering oral prednisolone which significantly improved his symptoms but failed to resolve the persistent low-grade AAU.
He was then reviewed by the paediatric rheumatology team who requested mycoplasma pneumoniae serology for the persistent cough and it showed elevated IgM and IgG antibodies. He was started on clarithromycin for one week. Symptoms and signs have completely resolved.
Mycoplasma pneumoniae-associated uveitis is rare and orbital involvement has not been reported before in existing literature. The condition warrants suspicion, especially in cases with concurrent chest symptoms.