# Coexistent Ankylosing Spondylitis and Ocular Toxocariasis in a Pediatric Patient Manifesting As Bilateral Panuveitis

## TL;DR

A 16-year-old male presented with both ankylosing spondylitis and ocular toxocariasis, a rare coexistence that caused complex symptoms requiring combined treatment.

## Contribution

This is the first reported case of juvenile spondyloarthritis and bilateral ocular toxocariasis coexisting in a pediatric patient.

## Key findings

- The patient exhibited generalized pustules, back pain, polyarthritis, and bilateral panuveitis.
- Toxocara IgG and HLA-B27 were positive, and MRI confirmed sacroiliitis.
- Treatment with triamcinolone and Etanercept stabilized visual acuity.

## Abstract

The coexistence of ankylosing spondylitis and ocular toxocariasis in the literature is rare and limited to a few case reports. Typically, such cases present as acute nongranulomatous anterior uveitis with Toxocara IgG seropositivity. A patient manifesting with findings of both ankylosing spondylitis and toxocariasis bilaterally has not been reported previously in the literature. We present a case of coexistent juvenile spondyloarthritis and ocular toxocariasis in a 16-year-old male presenting with generalized pustules, back pain, peripheral polyarthritis, and bilateral panuveitis. Both eyes displayed abnormalities in the anterior segments, including corectopia, seclusio pupillae, and occlusio pupillae. Posterior segment examination of the right eye showed vitritis, disc edema, and a retinochoroidal granuloma surrounded by infiltrates and perivascular sheathing. A B-scan of the left eye revealed vitritis and the presence of a hyperechoic band from the disc to the retinal periphery. Toxocara IgG and HLA-B27 were positive, and lumbosacral magnetic resonance imaging confirmed sacroiliitis. Treatment involved subtenon injections of triamcinolone and subcutaneous Etanercept injections, resulting in stabilization of visual acuity. This case highlights the rare co-occurrence of two diseases with overlapping symptoms and uncertain pathogenetic contributions from each to cause the observed manifestations. It supports studies proposing a connection between rheumatic disease and parasitosis.