Posterior Uveitis with Serous Retinal Detachment as a Severe Extra-Articular Manifestation of Psoriatic Arthritis: A Case Report

Abstract

Background: Psoriatic arthritis (PsA) is a chronic immune-mediated inflammatory disease that may be associated with extra-articular manifestations, including uveitis. Ocular involvement is uncommon in PsA and usually limited to anterior uveitis. Posterior uveitis complicated by serous retinal detachment is rare and potentially sight-threatening. Case Presentation: We report the case of a 52-year-old man with no significant past medical history, followed for psoriatic arthritis fulfilling the CASPAR criteria. The disease was initially well controlled with methotrexate. After several months, he developed unilateral visual impairment. Ophthalmologic examination revealed anterior uveitis (Tyndall 3+) associated with posterior uveitis complicated by serous retinal detachment. Extensive biological and imaging investigations excluded infectious causes. The patient was treated with intravitreal triamcinolone acetonide followed by infliximab (weeks 0, 2, and 6, then every 8 weeks), leading to marked improvement of both ocular and articular manifestations. Visual acuity improved from 2/10 at presentation to 7/10 at follow-up. Conclusion: This case highlights that psoriatic arthritis–associated uveitis may involve the posterior segment and lead to severe retinal complications. After exclusion of infectious etiologies, anti–TNF-α therapy represents an effective and steroid-sparing treatment option in severe PsA-associated uveitis.