Seasonal Hyperacute Panuveitis (SHAPU), a fulminant uveitis linked to exposure to Gazalina moths, is typically seen in children and classically presents as a painless ocular inflammation . This report describes a 27-year-old trekker from eastern Nepal who developed SHAPU after indirect contact with a moth at elevations ranging from 2,364 to 4,371 m — the highest altitude case reported to date. Clinical findings included circumcorneal congestion, anterior chamber reaction, vitritis, and a necrotizing scleral patch.
Despite aggressive multi-route steroid and antibiotic therapy, visual recovery was not achieved, although scleral perforation was prevented. This unusual painful presentation with necrotizing scleritis highlights that SHAPU may extend beyond uveal tissue to involve the sclera, suggesting new aspects of its pathophysiology and raising questions about the moth’s ecological…
