1. Rubella-virus associated uveitis
Aniki Rothova
Erasmus Medical Center Rotterdam, Netherlands

2. Ocular / General History
35-year-old female
presented with gradually decreasing visual acuity RE
General medical history: not contributory

3. Ocular findings at first presentation
Note the lighter blue color of RE and wider pupil RE

4. Ocular Examination OD: visual acuity 0.7
Keratic precipitates all around the corneal endothelium, mixed fine and mid-large
Cells in anterior chamber 1+
Subcapsular posterior cataract
Cells in anterior vitreous
No retinal abnormalities,
OS: visual acuity 1.25, no abnormalities
IOP 19/13 mmHg

5. Iris details
Note the widespread distribution of keratic precipitates and their mixed size (fine and mid-large) and small nodules on the pupillary rim in combination with visible fine vascular network on the iris

6. Presumed diagnosis: FHUS
Clinical diagnosis based on:
absence of acute inflammatory signs (no redness and pain)
cells in anterior chamber and vitreous, but no synechiae
cataract
additional findings: visible vasculature of the iris and hyphema development during intraocular surgery
20% bilateral involvement, 20% glaucoma, 10-15% “toxo-like” chorioretinal scars

7. Problems
Diagnosis of FHUS is clinical and causes of this syndrome may vary
High association with cataract and glaucoma
FHUS in Europe: % of cases have intraocular antibody production against RV
Not prevalent in vaccinated population

8. Additional Information
Patient was vaccinated according to official guidelines
Received rubella vaccine at the age of 11 (before the combination vaccine currently used)
Symptomatic rubella infection in our patient was not documented, but patient was probably infected before her vaccination

9. Examinations Aqueous analysis: PCR for HSV, VZV, CMV and RV: negative
Goldmann Witmer coefficient :
for HSV, VZV and CMV: negative
for Rubella virus =16 (highly positive, intraocular titers 1280> 260 serum titers)

10. Final Diagnosis Rubella virus-associated uveitis Follow-up:
Patient prefers to wait with cataract surgery
No treatment despite the cells +
Regular controls (cataract and glaucoma)

11. Conclusion
Fuchs heterochromic uveitis syndrome caused by Rubella virus:
No treatment for rubella virus available
Treatment with corticosteroids not satisfactory
Regular follow-up is indicated for control of cataract development and IOP increase