Spontaneous Hyphema Arising from HLA -B27 Positive Acute Anterior Uveitis: A Case Report

To report a rare case of spontaneous hyphema associated with human leukocyte antigen (HLA) -B27 positive acute anterior uveitis (AAU) and discuss its possible pathophysiological mechanisms and management. Observational case report of a 27-year-old Chinese man presented as acute anterior uveitis in the right eye (OD). A 27-year-old male presented with acute onset of pain, photophobia, and blurred vision in OD without a history of trauma. Ophthalmic examination revealed severe anterior uveitis in OD with 2 mm of spontaneous hyphema. Laboratory investigations confirmed HLA-B27 positivity, and radiographic findings established a diagnosis of ankylosing spondylitis (AS). The patient was treated with topical corticosteroids, cycloplegics, systemic corticosteroids, and tranexamic acid. He demonstrated significant clinical improvement with resolution of hyphema and reduction of anterior chamber inflammation by day nine. Spontaneous hyphema is an unusual complication of HLA-B27 positive AAU, likely resulting from severe inflammation-induced vasculitis. Early recognition and aggressive management with topical and systemic anti-inflammatory therapy can lead to favorable outcomes. This case highlights the importance of evaluating underlying systemic conditions in patients presenting with atypical anterior segment findings.