Poststreptococcal syndrome uveitis in South African children

Objective To describe the demographics, clinical features and management of the largest case series to date on poststreptococcal syndrome uveitis (PSU), a newly recognised immune-mediated response to group A beta-haemolytic streptococcus infection. Methods Case notes of all patients presenting to the Red Cross War Memorial Children's Hospital, Cape Town, with serologically confirmed PSU between 2004 and 2010, were retrospectively reviewed. Results A total of 22 cases were identified. Ages ranged from 4 to 12 years. 64% were black children and 64% were boys. Presenting visual acuities ranged from 6/6 to hand movements (median 6/24). 68% had bilateral disease. All had anterior uveitis (27% with posterior synechiae and 27% with hypopyon). 36% had vitritis and 23% had panuveitis. None had systemic illness or features of other poststreptococcal syndromes such as rheumatic fever, glomerulonephritis or polyarthritis. Anti-streptococcal titres (anti-streptolysin O and/or anti-deoxyribonuclease B) were significantly raised in all cases. Treatment comprised topical steroids and cycloplegic agents. Those with severe posterior segment involvement (41%) were treated with systemic corticosteroids. 55% received a course of oral penicillin. 82% had a single episode of uveitis. Four children had recurrences. Final visual acuities ranged from 6/6 to 6/36 (median 6/6). Conclusion This case series significantly increases the evidence for PSU currently available in the world literature. The condition can manifest with the full spectrum of ocular inflammation, and most cases respond well to standard uveitis regimens. The role of antibiotic therapy remains unclear and requires further investigation.