Trematodal granulomatous uveitis in paediatric Egyptian patients: a case series

Purpose To describe the clinical presentations and results of laboratory analysis of waterborne ophthalmic granulomas of the anterior chamber (AC) in Egyptian patients. Participants 110 patients with granulomatous anterior uveitis and distinctive AC nodules. Design Prospective, non-comparative, case series. Methods Demographic data including age, gender and place of residence were recorded. A full ophthalmic examination with emphasis on the inflammatory characteristics and systemic workup was performed. The nodules were surgically removed in selected cases and molecular and histopathological analyses were performed. Results 102 boys and 8 girls were recruited (mean age 11.5 years). All children came from villages along the basin of the River Nile in Egypt and were engaged in swimming in the local fresh water repertoires just prior to the development of the ocular lesions. 99 patients (103 eyes) showed active granulomatous anterior uveitis with distinct pearl-like white nodules in the AC measuring between 2 and 7 mm in diameter. Inactive scarred lesions were noted in 11 patients (12 eyes). Structural complications including cataract, corectopia and phthisis were documented in 29 eyes. PCR detected digenic trematode DNA in 6 out of 14 excised nodules. Histopathological examination showed aggregates of eosinophils and epithelioid cell granulomas. Conclusions In Egypt, a unique pattern of granulomatous anterior uveitis in rural children attributable to a waterborne helminthic infection is reported. The River Nile and its fresh water fauna are implicated in our series, and the need for an environmental investigation to further outline best management options in the given endemic areas is highlighted.