Post Streptococcal Ocular Rheumatism

The objectives of our study are, first, to highlight the different post-streptococcal ocular inflammatory disorders, to identify their clinical and diagnostic characteristics and to assess their evolution. Secondly, to group all these post-streptococcal ocular manifestations under the same name in order to distinguish them from other etiologies. Finally, we aim to propose diagnostic criteria for this entity. To this end, we opted for a prospective study

Post-streptococcal syndrome (PSS) is any non-suppurative systemic inflammation that occurs after streptococcal infection. Post-streptococcal uveitis (PSS) is already established as one of its manifestations. However, little has been written on the subject. 

we opted for a prospective study. The collection of cases took place in the ophthalmology department of the HMMI of Meknes, started in 2016, extended until 2020 and resulted in the compilation of 38 patients. The collection of cases met 2 criteria. -recurrent or chronic ocular involvement with no detectable etiology. - high ASLO titre and/or evidence of streptococcal infection. The initial work-up included a CBC, ESR, ASLO titre, throat swab and a Blondeauscan. The patient was followed up by ASLO titration, bacteriological study of the throat swab and an antibiotic susceptibility test repeated every 2 to 3 months and in case of relapse. 

Almost 46% of cases occurring in subjects under 15 years of age and over 85% of cases in subjects under 40 years of age. Moreover,  the M/F sex ratio was 1.1.The history of streptococcal infection was determined by history taking, ASLO titration, throat swab and Blondau-Scan .The involvement was mainly bilateral, dominated by non-granulomatous uveitis and characterised by a clinical polymorphism affecting all anatomical structures of the eye.The concomitant or delayed occurrence of other post-streptococcal complications was increased and should be investigated reciprocally if any of them occurred.No recurrence was observed after sterilisation of the foci, i.e. negativation of the samples and normalisation of the ASLO titre in all patients. 

All in all, the clinical heterogeneity of post-streptococcal ocular diseases and their similarity in terms of confirmation of the diagnosis, therapeutic management and prognosis, clearly show the interest of grouping the above-mentioned diseases under the same name "post-streptococcal ocular rheumatism (PSOR)" for which we propose diagnostic criteria.