At the Crossroads of Immunity: Immunosuppression in an HIV-Positive Child with JIA-Associated Uveitis

To report a case of a 5-year-old child with HIV infection who presented with juvenile idiopathic arthritis (JIA) and ocular involvement.

Retrospective observational case report.

A 5-year-old HIV-positive male child with vertically acquired infection, presented with diminution of vision in the left eye for two weeks. He had been on highly active antiretroviral therapy (HAART) for three years, with a recent CD4 count of 1495 cells/µL. Six months prior, he had developed bilateral anterior uveitis and was managed with topical corticosteroids and cycloplegics. Concurrent bilateral knee pain with subsequent investigations revealed a diagnosis of JIA, oligoarticular subtype, confirmed by a pediatric rheumatologist. Systemic workup revealed elevated rheumatoid factor and ANA, with negative ACE, Mantoux, HLA-B27, and anti-dsDNA. He was started on oral sulphasalazine, later switched to oral corticosteroids and methotrexate. At presentation, he had bilateral complicated cataracts with posterior synechiae. Fundus view was limited in the left eye, but B-scan confirmed an attached retina. The child underwent bilateral lens aspiration with intraocular lens implantation, following which BCVA improved to 6/9. A recurrence of anterior uveitis in the left eye required escalation of methotrexate and reintroduction of corticosteroids. With careful multidisciplinary coordination and close follow-up, his uveitis remained controlled, and visual outcomes remained excellent (BCVA 6/9 right eye, 6/7.5 left eye) two years after surgery.

A child with HIV and JIA can be managed with help of multidisciplinary approach. Care should be taken in planning the judicious use of immunosuppressants alongside HAART, as this combination can help control inflammation while maintaining viral suppression.