A 53-year-old woman who saw multiple specialists for red eyes, blurred vision, floaters, and light sensitivity was ultimately diagnosed with post-streptococcal uveitis syndrome (PSUS), a rare immune-mediated eye condition usually seen in children and young adults. The case, published in BMJ Case Reports, is only the second reported in a patient over 50, according to Norman Saffra and colleagues.
The woman's symptoms began about a day after an upper endoscopy, when she developed throat discomfort and was diagnosed with culture-positive strep pharyngitis. Shortly after that resolved, she developed eye symptoms in both eyes. Examination showed signs of inflammation including cells and flare, cystoid macular edema, vitreous cells, optic nerve head edema, and vasculitis. The authors note that prior clinicians had not connected the strep infection to the eye symptoms.
PSUS is thought to involve molecular mimicry, where immune responses to streptococcal antigens cross-react with retinal S-antigen. Diagnosis relies on elevated ASO or anti-DNase B titers plus clinical findings after excluding other causes. Treatment included topical difluprednate, cyclopentolate, and oral prednisone; inflammation persisted for 8 months, delaying steroid tapering until ASO titers normalized. At 22 months, the patient was disease-free with 20/20 vision in both eyes.
The authors emphasize that clinicians should consider post-strep syndromes in adults, not just children, and be alert to possible recurrence or delayed presentation. They stress that taking a thorough history is critical to connecting a recent strep infection to unexplained uveitis.