1
|
Morel N, Bonnet C, Mehawej H, Le Guern V, Pérard L, Roumier M, Brezin A, Godeau B, Haroche J, Benhamou Y, Lambert M, Yelnik CM, Maillard N, Bodaghi B, Piette JC, Costedoat-Chalumeau N. CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME AND POSTERIOR OCULAR INVOLVEMENT: Case Series of 11 Patients and Literature Review. Retina 2021; 41:2332-2341. [PMID: 33840791 DOI: 10.1097/iae.0000000000003185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the posterior ophthalmic manifestations of catastrophic antiphospholipid syndrome. METHODS Retrospective case series of patients presenting with catastrophic antiphospholipid syndrome and posterior segment ocular manifestations. The main outcomes were the type of posterior segment manifestations at catastrophic antiphospholipid syndrome diagnosis, specifically retinal vascular occlusion, vasculitis, or choroidopathy, and the final best-corrected visual acuity. RESULTS This study included 23 patients (11 cases treated by the authors and 12 published case reports); 21 (91%) of them female. Their median age at diagnosis was 28 years (range, 16-79 years). Ophthalmologic manifestations were usually bilateral (n = 19, 83%) and involved vascular occlusive retinopathy (n = 17, 74%), choroidopathy (n = 11, 48%), or retinal vasculitis (n = 1, 4%). Final best-corrected visual acuity was not significantly worse than the best-corrected visual acuity at diagnosis (P = 0.16). Retinal vascular occlusions were associated with poorer final visual acuity than choroidopathy (P = 0.002). After a median follow-up of 14 months (range, 2-132 months), nearly half the patients (n = 11, 48%) had permanent vision loss including best-corrected visual acuity of <20/400 for 4 patients. CONCLUSION Posterior ophthalmic manifestations of catastrophic antiphospholipid syndrome were mainly bilateral retinal vascular occlusion, which had the worst visual prognosis, followed by choroidopathy and retinal vasculitis. Permanent visual loss was common.
Collapse
Affiliation(s)
- Nathalie Morel
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Cochin Hospital, Paris, France
| | - Clémence Bonnet
- Université Paris-Descartes, Paris, France
- Ophthalmology Department, AP-HP, Cochin Hospital, Paris, France
| | - Hanane Mehawej
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Cochin Hospital, Paris, France
| | - Véronique Le Guern
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Cochin Hospital, Paris, France
| | - Laurent Pérard
- Centre Hospitalier Saint Joseph Saint Luc, Internal Medicine Department, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | | | - Antoine Brezin
- Ophthalmology Department, AP-HP, Cochin Hospital, Paris, France
| | - Bertrand Godeau
- Internal Medicine Department, AP-HP, Henri Mondor Hospital, Creteil, France
| | - Julien Haroche
- Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Louisiana Pitié-Salpêtrière Hospital, Paris, France
| | - Ygal Benhamou
- Department of Internal Medicine, Vascular and Thrombosis Unit, Normandie Université, UNIROUEN, Rouen University Hospital, Rouen, France
| | - Marc Lambert
- Internal Medicine Department, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University Lille, INSERM U1167, CHU Lille, Lille, France
| | - Cécile M Yelnik
- Internal Medicine Department, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University Lille, INSERM U1167, CHU Lille, Lille, France
| | - Nicolas Maillard
- Department of Internal Medicine, CHU, de Saint-Etienne, France; and
| | - Bahram Bodaghi
- Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Louisiana Pitié-Salpêtrière Hospital, Paris, France
| | - Jean-Charles Piette
- Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Louisiana Pitié-Salpêtrière Hospital, Paris, France
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Cochin Hospital, Paris, France
- AP-HP, Cochin Hospital, Internal Medicine department, Centre de référence maladies auto-immunes et systémiques rares de l'Ile de France, INSERM U 1153, Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| |
Collapse
|
2
|
Franco AMDM, Medina FMC, Balbi GGM, Levy RA, Signorelli F. Ophthalmologic manifestations in primary antiphospholipid syndrome patients: A cross-sectional analysis of a primary antiphospholipid syndrome cohort (APS-Rio) and systematic review of the literature. Lupus 2020; 29:1528-1543. [PMID: 32814509 DOI: 10.1177/0961203320949667] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is a broad spectrum of eye involvement in antiphospholipid syndrome (APS). The majority of descriptions are presented as case reports that include mostly APS patients secondary to systemic lupus erythematosus (SLE), with no compelling evidence in primary APS (PAPS). This study aimed to describe ocular manifestations in our well-defined PAPS cohort (APS-Rio) and then perform a systematic literature review (SLR) of ocular manifestations in patients with APS or positivity to aPL without SLE. METHODS We retrospectively analyzed PAPS patients followed at our outpatient clinics. All patients fulfilled Sydney APS classification criteria (2006). We evaluated them for ocular symptoms and previous ocular diagnoses. Antiphospholipid antibodies and clinical APS manifestations were compared between patients with and without ocular manifestations. For the SLR, electronic databases were searched up to November 2019. RESULTS We studied 105 PAPS patients; 90.5% were female and 56.2% were Caucasian. We found ocular manifestations in 37.1% of our cohort. Thrombosis was the main criteria manifestation (95.2%) and lupus anticoagulant was the most prevalent antibody. Ophthalmologic diagnoses were present in 7 patients, with 5 having retinal vessels thromboses. Amaurosis fugax was the leading complaint, present in 30 patients. In the univariate analysis, amaurosis fugax was related to livedo (p = 0.005), Raynaud's phenomenon (p = 0.048) and the presence of anticardiolipin antibody (≥40 GPL/MPL) (p = 0.041). Hemianopia was associated with arterial hypertension (p = 0.049). In the multivariate analysis, the only association found was between livedo and amaurosis fugax (OR 4.09, 95%CI 1.5-11.11, p = 0.006). Our SLR incorporated 96 articles of ocular manifestations in patients with PAPS or positivity to aPL without SLE. Ocular findings varied from 5 to 88%, including anterior and posterior segments, orbital and neuro-ophthalmologic changes. CONCLUSION There is little evidence on ocular manifestations in PAPS. We described an association between livedo and amaurosis fugax. Prospective studies are needed to promote the best treatment and avoid blindness in PAPS patients.
Collapse
Affiliation(s)
- Adriana M de M Franco
- Department of Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Ophthalmology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Brazil
| | - Flavio Mac Cord Medina
- Department of Ophthalmology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Brazil
| | | | - Roger Abramino Levy
- Department of Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flavio Signorelli
- Department of Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
3
|
de Souza A, Desai PK, de Souza RJ. Acute multifocal neuropathy following cocaine inhalation. J Clin Neurosci 2016; 36:134-136. [PMID: 27815025 DOI: 10.1016/j.jocn.2016.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/08/2016] [Accepted: 10/15/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We report a young man, not a habitual cocaine user, who developed an acute multifocal neuropathy following a second exposure to inhaled cocaine. METHODS Case report. RESULTS Clinical and electrophysiological findings suggested an acute multiple mononeuropathy following cocaine exposure. Imaging of the shoulder and pelvic girdles revealed multifocal denervation in selected proximal muscles. The patient was empirically treated with intravenous steroids to good effect. DISCUSSION Cocaine use, although usually affecting the central nervous system, does produce peripheral nerve disease in rare instances. This unusual pattern of neurological involvement needs to be differentiated from the more common symptoms resulting from affection of the brain.
Collapse
Affiliation(s)
- Aaron de Souza
- Apollo Victor Hospital, Malbhat, Margao, Goa 403 601, India; NeuroCare, Pereira Plaza, Margao, Goa 403 601, India.
| | - Paresh K Desai
- Apollo Victor Hospital, Malbhat, Margao, Goa 403 601, India
| | | |
Collapse
|