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Triggianese P, D'Antonio A, Nesi C, Kroegler B, Di Marino M, Conigliaro P, Modica S, Greco E, Nucci C, Bergamini A, Chimenti MS, Cesareo M. Subclinical microvascular changes in ANCA-vasculitides: the role of optical coherence tomography angiography and nailfold capillaroscopy in the detection of disease-related damage. Orphanet J Rare Dis 2023; 18:184. [PMID: 37430363 DOI: 10.1186/s13023-023-02782-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/18/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Both cardiovascular and complement-mediated disorders might lead to microvascular damages in anti-neutrophil cytoplasm autoantibodies (ANCA)-associated vasculitides (AAV). We aimed at investigating, for the first time, subclinical microvascular abnormalities with non-invasive techniques in AAV patients by analyzing both retinal and nailfold capillary changes. Retinal plexi were investigated using optical coherence tomography angiography (OCT-A), while nailfold capillary changes by video-capillaroscopy (NVC). Potential correlations between microvessels' abnormalities and disease damage were also explored. METHODS An observational study was conducted on consecutive patients who met the inclusion criteria of defined diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA), granulomatosis with polyangiitis (GPA), and microscopic polyangiitis (MPA), age ≥ 18 ≤ 75 yrs, and no ophthalmological disorders. Disease activity was assessed by Birmingham Vasculitis Activity Score (BVAS), damage by Vasculitis Damage Index (VDI), and poorer prognosis by the Five Factor Score (FFS). Quantitative analysis of vessel density (VD) was performed by OCT-A in both superficial and deep capillary plexi. Figures and detailed analysis from NVC were performed for all subjects in the study. RESULTS Included AAV patients (n = 23) were compared with 20 age/sex-matched healthy controls (HC). Retinal VD in superficial whole and parafoveal plexi resulted significantly decreased in AAV compared to HC (P = 0.02 and P = 0.01, respectively). Furthermore, deep whole and parafoveal vessel density was strongly reduced in AAV than HC (P ≤ 0.0001 for both). In AAV patients, significant inverse correlations occurred between VDI and OCTA-VD in both superficial (parafoveal, P = 0.03) and deep plexi (whole, P = 0.003, and parafoveal P = 0.02). Non-specific NVC pattern abnormalities occurred in 82% of AAV patients with a similar prevalence (75%) in HC. In AAV, common abnormalities were edema and tortuosity in a comparable distribution with HC. Correlations between NVC changes and OCT-A abnormalities have not been described. CONCLUSION Subclinical microvascular retinal changes occur in patients with AAV and correlate with the disease-related damage. In this context, the OCT-A can represent a useful tool in the early detection of vascular damage. AAV patients present microvascular abnormalities at NVC, whose clinical relevance requires further studies.
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Affiliation(s)
- P Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, 00133, Italy.
| | - A D'Antonio
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, 00133, Italy
| | - C Nesi
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, 00133, Italy
| | - B Kroegler
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, 00133, Italy
| | - M Di Marino
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, 00133, Italy
| | - P Conigliaro
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, 00133, Italy
| | - S Modica
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, 00133, Italy
| | - E Greco
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, 00133, Italy
| | - C Nucci
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, 00133, Italy
| | - A Bergamini
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, 00133, Italy
| | - M S Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, 00133, Italy
| | - M Cesareo
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, 00133, Italy
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Jari M, Rastinmaram Z, Niazi E, Mousavi Z. Conjunctivitis as the important indicator of pediatric granulomatosis with polyangiitis. SAGE Open Med Case Rep 2022; 10:2050313X221114727. [PMID: 36090534 PMCID: PMC9459451 DOI: 10.1177/2050313x221114727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/04/2022] [Indexed: 11/15/2022] Open
Abstract
Granulomatosis with polyangiitis disease is a rare vasculitis characterized by granulomatous inflammation of respiratory tracts and glomerulonephritis along with vasculitis of other organs. In this study, a 14- year-old boy was referred from ophthalmology clinic to the pediatric rheumatology ward due to drug-resistant conjunctivitis. He had a history of chronic rhinorrhea and nighttime coughing, and he was diagnosed with allergic rhinitis. Complete blood count showed leukocytosis and thrombocytosis, and the estimated sedimentation rate was elevated. Laboratory tests showed hematuria, proteinuria, and highly positive antineutrophil cytoplasmic antibody. Moreover, sinus computed tomography demonstrated pansinusitis, and spiral chest computed tomography showed multiple pulmonary nodules in both his lungs. Finally, based on renal biopsy, the patient was confirmed as a case of granulomatosis with polyangiitis. It is notable that acute or chronic conjunctivitis may be a manifestation of rheumatic diseases.
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Affiliation(s)
- Mohsen Jari
- Department of Pediatric Rheumatology, Imam Hossein Children’s Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Elahe Niazi
- Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Mousavi
- Isfahan University of Medical Sciences, Isfahan, Iran
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Kojima T, Dogru M, Shimizu E, Yazu H, Takahashi A, Shimazaki J. Atypical Granulomatosis with Polyangiitis Presenting with Meibomitis, Scleritis, Uveitis and Papillary Bladder Tumor: A Case Report and Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11040680. [PMID: 33918928 PMCID: PMC8069415 DOI: 10.3390/diagnostics11040680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 12/18/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) presents with a variety of systemic findings, sometimes with ocular findings initially, but is often difficult to diagnose at an early stage. An 85-year-old male had complaints of ocular dryness and redness and was diagnosed with meibomian gland dysfunction with meibomitis. Despite an initial treatment with topical steroid and antibiotics, the meibomitis did not improve and the left eye developed scleritis and iridocyclitis. The patient was administered topical mydriatics and oral steroids. During follow-up, the patient developed left hearing difficulty and reported a darker urine. Urinalysis revealed microscopic hematuria. A blood test showed an elevated erythrocyte sedimentation rate, positivity for perinuclear anti-neutorophil cytoplasmic antibody, and elevations in blood urea nitrogen and serum creatinine. Nasal mucosal biopsy showed a non-necrotizing granulomatous inflammation. Renal biopsy revealed focal glomerulosclerosis. Cystoscopy and bladder wash followed by a planned transurethral resection revealed atypical cells and apical papillary tumors which were resected. Iridocyclitis and scleritis responded well to oral prednisolone with 0.1% topical betamethasone and prednisolone ointment. The patient is tumor free with no recurrences 24 months after resection. GPA may present atypically with meibomian gland dysfunction without showing representative clinical findings. Early detection and treatment are essential for visual recovery.
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Affiliation(s)
- Takashi Kojima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (T.K.); (E.S.); (H.Y.)
| | - Murat Dogru
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (T.K.); (E.S.); (H.Y.)
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba 272-8513, Japan; (A.T.); (J.S.)
- Department of Ophthalmology, Tsurumi University School of Dental Medicine, Kanagawa 230-8501, Japan
- Correspondence: ; Tel.: +81-3-5363-2012
| | - Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (T.K.); (E.S.); (H.Y.)
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba 272-8513, Japan; (A.T.); (J.S.)
| | - Hiroyuki Yazu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (T.K.); (E.S.); (H.Y.)
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba 272-8513, Japan; (A.T.); (J.S.)
- Department of Ophthalmology, Tsurumi University School of Dental Medicine, Kanagawa 230-8501, Japan
| | - Aya Takahashi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba 272-8513, Japan; (A.T.); (J.S.)
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba 272-8513, Japan; (A.T.); (J.S.)
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Nelson PC, Kunam V, Prospero Ponce C. Atypical painless vision loss in a patient with granulomatosis with polyangiitis. GMS OPHTHALMOLOGY CASES 2020; 10:Doc46. [PMID: 33384913 PMCID: PMC7745643 DOI: 10.3205/oc000173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Vasculitis is a common cause of vision loss, and typically painful. In giant cell arteritis, the most common primary vasculitis in adults, we see elevated inflammatory markers, granulomatous inflammation, and associated headache or scalp tenderness. Vision loss caused by granulomatous with polyangiitis (GPA) is rare and typically associated with pain and orbital findings. Our patient presented for shortness of breath and painless vision loss without orbital inflammation or neural enhancement and a normal fundus exam, suggesting posterior ischemic optic neuropathy. Collaboration amongst sub-specialties and obtaining tissue samples are key to diagnosing granulomatosis with polyangiitis to ensure timely treatment of this fatal and blinding disease.
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Affiliation(s)
- Patricia C Nelson
- Ophthalmology, Department of Surgery, Texas Tech University Health Sciences Center El Paso, United States
| | - Vamsi Kunam
- Interventional Radiology, Department of Radiology, Texas Tech University Health Sciences Center El Paso, United States
| | - Claudia Prospero Ponce
- Ophthalmology, Department of Surgery, Texas Tech University Health Sciences Center El Paso, United States
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Alshammari K, Al Hothaly B, Alrabiah F. Case of Nocardia Cyriacigeorgica Infection of the Eye in a Granulomatosis With Polyangiitis Patient. Cureus 2020; 12:e11178. [PMID: 33133800 PMCID: PMC7593125 DOI: 10.7759/cureus.11178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Nocardiosis is an infectious disease caused by a group of organisms that are often found in soil and has a very rare incidence of infecting immunocompromised patients. Granulomatosis with polyangiitis patients are often susceptible to being infected with many atypical organisms such as Nocardia cyriacigeorgica. We present a case of a 35-year-old male who is a known case of granulomatosis with polyangiitis and has a repeated history of farm visits. The patient presented with progressive early morning right eye secretions followed by dryness throughout the day with no history of trauma or allergy of seven months duration. An eye swab for culture and sensitivity showed an isolated Nocardia cyriacigeorgica and was treated by trimethoprim/sulfamethoxazole (Bactrim) for one year but was lost to follow-up. Early detection of Nocardia cyriacigeorgica is crucial in those groups of patients, as it can prevent further complicated outcomes while proper hygiene education is important.
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Affiliation(s)
| | - Bushra Al Hothaly
- Infectious Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Fahad Alrabiah
- Infectious Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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Takagi M, Kobayashi T, Kida T, Takai N, Shoda H, Maruyama K, Tada R, Makino S, Ikeda T. Development of central retinal artery occlusion accompanied by choroidal folds in a patient with antineutrophil cytoplasmic antibody-associated vasculitis: A case report. Medicine (Baltimore) 2020; 99:e21934. [PMID: 32871935 PMCID: PMC7458181 DOI: 10.1097/md.0000000000021934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE We report a case of central retinal artery occlusion (CRAO) accompanied by choroidal folds in a patient positive for myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA). PATIENT CONCERNS The study involved a 67-year-old female patient who presented at the Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Osaka, Japan on October 24, 2016 after becoming aware of a sudden decrease of visual acuity (VA) in her right eye. Other than suffering with scleritis 6-months previous, there was no obvious past history. DIAGNOSIS Upon examination, the VA in her right eye was hand motion, and the anterior segment of that eye showed thinning of the superior sclera. Macular edema in the inner retina and cherry red spots were observed in the ocular fundus, and optical coherence tomography (OCT) findings showed hyperreflectivity of the inner retina and choroidal folds. Fluorescein angiography (FA) examination of the fundus showed scattered areas of no retinal perfusion, and indocyanine green angiography (IA) findings of the fundus indicated a possible choroidal circulatory disturbance in her right eye. Blood test findings revealed the patient to be positive for MPO-ANCA. Based on the above findings, the patient was diagnosed with CRAO and choroidal circulatory disturbance due to ANCA-associated vasculitis. INTERVENTIONS For treatment, steroid semi-pulse therapy was initiated. OUTCOMES Post treatment initiation, the fundus features and choroidal folds gradually improved, and her VA slightly improved to 0.08. LESSONS Based on the FA, IA, and OCT findings, the present case was considered to have CRAO accompanied by choroidal circulatory disturbance due to ANCA-associated vasculitis, a rare disease that may be complicated by choroidal circulatory disturbances.
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Affiliation(s)
- Mai Takagi
- Department of Ophthalmology, Osaka Medical College
| | | | - Teruyo Kida
- Department of Ophthalmology, Osaka Medical College
| | - Nanae Takai
- Department of Ophthalmology, Osaka Medical College
| | - Hiromi Shoda
- Department of Ophthalmology, Osaka Medical College
| | | | | | - Shigeki Makino
- Department of Internal Medicine, Osaka Medical College, Takatsuki-City, Osaka, Japan
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Abroug N, Zina S, Khairallah M, Ksiaa I, Kechida M, Ben Amor H, Khochtali S, Khairallah M. Diagnosing retinal vasculitis and its implications for treatment. EXPERT REVIEW OF OPHTHALMOLOGY 2019. [DOI: 10.1080/17469899.2019.1613153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Molka Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Melek Kechida
- Internal Medicine Department, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hager Ben Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Mammo DA, McClelland CM, Chen J, Adams MK, Pulido J, Davies JB. Isolated cilioretinal artery occlusion secondary to perinuclear antineutrophil cytoplasmic antibody vasculitis. Eur J Ophthalmol 2019; 30:NP53-NP57. [PMID: 30947529 DOI: 10.1177/1120672119841541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Antineutrophil cytoplasm antibody-associated vasculitides encompass a diverse spectrum of autoimmune diseases characterized by necrotizing small vessel vasculitis. Ocular manifestations may be the presenting findings of antineutrophil cytoplasm antibody-associated vasculitides. METHODS Single, retrospective case study. RESULTS We report the rare case of a 55-year-old woman with a cilioretinal artery occlusion as the presenting feature of perinuclear antineutrophil cytoplasm antibody-associated microscopic polyangiitis. CONCLUSIONS Although rare, antineutrophil cytoplasm antibody-related vasculitis should be considered in any retinal vascular occlusion, particularly in the setting of patients with new vague headaches and a paucity of vasculopathic risk factors.
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Affiliation(s)
- Danny A Mammo
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - Collin M McClelland
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - John Chen
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Matthew K Adams
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Jose Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
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Sfiniadaki E, Tsiara I, Theodossiadis P, Chatziralli I. Ocular Manifestations of Granulomatosis with Polyangiitis: A Review of the Literature. Ophthalmol Ther 2019; 8:227-234. [PMID: 30875067 PMCID: PMC6513923 DOI: 10.1007/s40123-019-0176-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Indexed: 11/27/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a rare systemic autoimmune disease of unknown etiology that is characterized by granulomatous inflammation, tissue necrosis, and vasculitis in small- and medium-sized vessels. Ocular and orbital manifestations are common in almost half of patients with GPA, affecting every structure of the eye, from the eyelid and orbit to the retina, the choroid, and the optic nerve, with a wide range of severity. Since imaging findings are not always specific for the diagnosis of GPA, biopsy is useful to confirm the diagnosis. Regarding treatment, a localized pharmaceutical and surgical approach may be helpful to achieve remission, while immunosuppressive therapy, corticosteroids, and cyclosporine are also useful. In any case, multidisciplinary intervention is required to reduce the rates of relapse and morbidity in patients with GPA.
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Affiliation(s)
- Evdokia Sfiniadaki
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Tsiara
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece.
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Nejabat M, Mahmoudi Nezhad GS, Shenavandeh S, Ashraf MJ, Jalalpour MH. Conjunctivitis as a manifestation of Wegener's Granulomatosis. J Curr Ophthalmol 2018; 30:268-272. [PMID: 30197959 PMCID: PMC6127366 DOI: 10.1016/j.joco.2017.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 10/17/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose To report a case of prolonged conjunctivitis as the manifestation of Granulomatosis with polyangiitis (GPA). Methods A 37-year-old man presented with prolonged conjunctivitis which had persisted for one month. He was taking medication for his conjunctivitis without any response. A slit-lamp examination revealed conjunctivitis and scleritis in the right eye. Conjunctivitis, 360-degree peripheral corneal thinning, corneal perforation, and scleritis were seen in the left eye. Results Emergency penetrating keratoplasty was performed to treat the patient's corneal perforation. After a consultation with the Internal Medicine Department, the patient was suspected of having GPA with positive cytoplasmic anti-neutrophil cytoplasmic antibodies (C-ANCA). Functional endoscopic sinus surgery was performed to treat right maxillary sinusitis, and a biopsy of the maxillary sinus mucosa was obtained. The pathology report showed granuloma and vasculitis with severe acute and chronic inflammation and few eosinophils; thus, the diagnosis was confirmed. Conclusion Because prolonged conjunctivitis occurs only rarely in association with systemic disease, ophthalmologists should be aware of this potential, particularly in patients with GPA.
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Affiliation(s)
- Mahmoud Nejabat
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Golnoush Sadat Mahmoudi Nezhad
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeedeh Shenavandeh
- Department of Rheumatology, Namazee Hospital, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Javad Ashraf
- Department of Pathology, Khalili Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hassan Jalalpour
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Corresponding author. Department of Ophthalmology, Khalili Hospital, Shiraz, Iran.
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Saati S, Sadda SR. Seronegative granulomatous polyangiitis with central retinal artery occlusion as the initial manifestation. Retin Cases Brief Rep 2014; 8:236-239. [PMID: 25372516 DOI: 10.1097/icb.0000000000000109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To report a case of central retinal artery occlusion in a patient with autopsy-verified granulomatous polyangiitis (GP) with negative cytoplasmic antineutrophil cytoplasmic antibody. METHODS Case report. RESULTS A 61-year-old Hispanic man with history of tuberculosis was admitted to the hospital with worsening dyspnea. Two weeks later, he experienced sudden vision loss due to central retinal artery occlusion in his right eye. A CT of the lung revealed multiple opacities. He developed renal failure during his hospital stay. A serum cytoplasmic antineutrophil cytoplasmic antibody test was negative. Pulmonary biopsy disclosed chronic inflammation with no evidence of granuloma formation or vasculitis. He died of acute respiratory distress due to bilateral deep vein thrombosis of his lower extremities. Autopsy revealed GP. CONCLUSION Granulomatous polyangiitis is a multisystem vasculitic disorder. Central retinal artery occlusion as the presenting manifestation of GP is very uncommon. This report demonstrates the difficulty of diagnosing GP, particularly when initial diagnostic assays (including both serology and biopsy) were negative for GP.
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Affiliation(s)
- Saloomeh Saati
- *Department of Ophthalmology, University of Southern California, Los Angeles, California; and †Doheny Eye Institute, University of California, Los Angeles, California
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