Rubella-virus associated uveitis
Aniki Rothova
Erasmus Medical Center Rotterdam,
Netherlands
Ocular / General History
 35-year-old
female
 presented with gradually decreasing
visual acuity RE
 General medical history: not contributory
Ocular findings at first presentation
Note the lighter blue color of RE and wider pupil RE
Ocular Examination
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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
Iris details
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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
Presumed diagnosis: FHUS
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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
Problems
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Diagnosis of FHUS is clinical and causes of this
syndrome may vary
High association with cataract and glaucoma
FHUS in Europe: 95-100% of cases have
intraocular antibody production against RV
Not prevalent in vaccinated population
Additional Information
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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
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)

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)
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