Beyond the Usual: A Case Series on Atypical Manifestations of HLA-B27 Uveitis

PURPOSE: To report a series of patients with HLA-B27-associated uveitis presenting with atypical features, highlighting uncommon patterns and associated diagnostic challenges. METHOD: Retrospective Chart Review. RESULT: A total of nine patients with HLA-B27-associated uveitis were included, predominantly males in the third to fourth decade, with most having underlying HLA-B27-associated spondyloarthropathy. The majority presented with anterior and intermediate uveitis with disproportionately severe vitritis (grade 3-4+), exceeding typical spillover inflammation, with pars plana exudates in some cases. One patient was misdiagnosed as endogenous endophthalmitis and underwent vitrectomy. Fundus view was obscured in three eyes due to dense vitritis, and posterior segment findings included serous retinal detachment, pars plana exudates, glaucomatous optic atrophy, and choroidal neovascular membrane. CONCLUSION: HLA-B27-associated uveitis can present with atypical features, including significant vitritis and posterior segment involvement, leading to diagnostic dilemmas. This case series highlights the need for a high index of suspicion and accurate anatomical classification to guide appropriate management.