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Baima JPS, Silva BCG, Vieira VL, Meireles LP, Arai MH, Lino AMM. A great simulator in clinical practice: mononeuritis multiplex in HIV infection. Autops Case Rep 2024; 14:e2024493. [PMID: 39021464 PMCID: PMC11253905 DOI: 10.4322/acr.2024.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 04/21/2024] [Indexed: 07/20/2024]
Abstract
HIV infection is a chameleon, mimicking several diseases. Herein, we report a previously healthy 39-year-old woman who, over 2 months, developed arthritis, weight loss, and confluent multiple mononeuropathy. Extensive laboratory investigation showed positive serology for HIV, with a CD4 count of 100 cells, and necrotizing vasculitis on a nerve biopsy not associated with CMV co-infection, allowing the diagnosis of polyarteritis nodosa-like vasculitis in an HIV-infected patient. Apart from the infection, HIV-related autoimmunity can affect any organ and contribute to the complexity of the clinical presentation of HIV infection.
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Affiliation(s)
- José Pedro Soares Baima
- Universidade de São Paulo (USP), Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo, SP, Brasil
| | - Beatriz Carneiro Gondim Silva
- Universidade de São Paulo (USP), Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo, SP, Brasil
| | - Vanessa Lopes Vieira
- Universidade de São Paulo (USP), Hospital das Clínicas, Faculdade de Medicina, Departamento de Medicina Interna, São Paulo, SP, Brasil
| | - Luiz Pedro Meireles
- Universidade de São Paulo (USP), Hospital das Clínicas, Faculdade de Medicina, Departamento de Medicina Interna, São Paulo, SP, Brasil
| | - Milton Hideaki Arai
- Universidade de São Paulo (USP), Hospital das Clínicas, Faculdade de Medicina, Departamento de Medicina Interna, São Paulo, SP, Brasil
| | - Angelina Maria Martins Lino
- Universidade de São Paulo (USP), Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo, SP, Brasil
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Abdouli N, Haulot T, Pourjavan S. Permanent Severe Visual Field Defect Following Pre-eclampsia and Multiple Ophthalmological Pathologies: A Case Report. Cureus 2024; 16:e63052. [PMID: 39050330 PMCID: PMC11268793 DOI: 10.7759/cureus.63052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
This clinical report discusses the interplay of various pathologies that may present similar clinical manifestations, with uncertainty about the distinct impact of each one of them. The patient is a 43-year-old young Asian female with no known medical conditions. She was 33 weeks pregnant when she was admitted for an urgent c-section because of preeclampsia with HELLP syndrome. While hospitalized, she complained about the visual field's loss. A comprehensive ophthalmological examination revealed a severe concentric visual field defect along with well-reduced visual acuity and impaired color vision. Her OCT revealed a bilateral serous macular detachment related to pre-eclampsia. A brain MRI revealed a microstroke at the temporo-parieto-occipital junction (TPO), although it did not fully account for the severity of the visual field deficit. Despite the macular pathology being resolved, the visual field remained deeply impacted. A thorough and complete investigation yielded negative results, leaving the cause of the patient's deficit unknown. The patient likely had a normal pressure glaucoma. Additionally, multifactorial bilateral microvascular ischemic neuropathy (caused especially by high myopia) has significantly affected her visual field. Furthermore, it is also probable that the patient had genetic neuropathy. Initial genetic testing was negative; however, due to the high suspicion of a genetic component, a retest was conducted, and the results were not conclusive. This case represents a highly unusual case of a profoundly affected visual field with no apparent identified cause. This is a notable example of the potential interaction of various local and systemic pathologies that can manifest with similar clinical presentations.
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Affiliation(s)
- Nasim Abdouli
- Ophthalmology, Cliniques Universitaires Saint-Luc, Brussels, BEL
| | - Thomas Haulot
- Ophthalmology, Cliniques Universitaires Saint-Luc, Brussels, BEL
| | - Sayeh Pourjavan
- Ophthalmology, Cliniques Universitaires Saint-Luc, Brussels, BEL
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Rana R, Thakali A, Shrestha UK, Sharma R, Chapagain S. Optic Neuropathy as a Rare Ocular Complication of Acute Pancreatitis: A Case Report. Cureus 2024; 16:e54234. [PMID: 38496136 PMCID: PMC10944141 DOI: 10.7759/cureus.54234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
Acute pancreatitis is a pancreatic inflammatory disorder that often leads to multi-organ dysfunction associated with systemic inflammatory response. Optic neuropathy is an extremely rare ocular manifestation that can occur especially in alcoholic pancreatitis most likely due to ischemic complications and is a vision-threatening condition that has to be recognized early as it can cause permanent vision loss. In this case report, a 51-year-old lady, an occasional consumer of alcohol, post-cholecystectomy status, presented with severe abdominal pain of four days' duration associated with multiple episodes of vomiting. She was diagnosed with moderate to severe acute pancreatitis and needed ionotropic support initially. She had improvement in gastrointestinal symptoms. However, she had left peri-orbital pain and lacrimation with blurring of vision on Day 11 of illness. Subsequently, an ophthalmic evaluation revealed optic disc oedema and a mild decrease in visual acuity but normal visual field and colour vision. Therefore, left optic neuropathy was diagnosed and a high-dose oral steroid was started on a tapering dose. Follow-ups after four and 12 weeks showed significant improvement in optic disc oedema and other symptoms. Therefore, though optic neuropathy is rarely reported in acute pancreatitis, it has to be considered in clinical practice along with Purtscher-like retinopathy, which presents with ocular symptoms in acute pancreatitis.
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Affiliation(s)
- Ramesh Rana
- Department of Gastroenterology and Hepatology, Nepal Mediciti Hospital, Lalitpur, NPL
| | - Ashwin Thakali
- Department of Ophthalmology, Nepal Mediciti Hospital, Lalitpur, NPL
| | - Umid Kumar Shrestha
- Department of Gastroenterology and Hepatology, Nepal Mediciti Hospital, Lalitpur, NPL
| | - Rabin Sharma
- Department of Gastroenterology and Hepatology, Nepal Mediciti Hospital, Lalitpur, NPL
| | - Senny Chapagain
- Department of Ophthalmology, Nepal Mediciti Hospital, Lalitpur, NPL
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Cardoso D, Bezerra S, Soares-dos-Reis R, Sá MJ, Guimarães J. Optic neuropathy diagnosis in the emergency room - retrospective observational study of the last 18 years. Eur J Ophthalmol 2024; 34:267-280. [PMID: 37218168 PMCID: PMC10757394 DOI: 10.1177/11206721231173005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 04/06/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Optic neuropathies (ON), a broad spectrum of disorders of the optic nerve, are a frequent cause of visual loss, presenting either in isolation or associated to neurological or systemic disorders. They are often first evaluated in the Emergency Room (ER) and a rapid determination of the etiology is imperative for implementing timely and appropriate treatment. We aim to describe ER demographic data and clinical characteristics, as well as the performed imaging exams, of patients subsequently hospitalized and diagnosed with ON. Furthermore, we seek to explore the accuracy of ER discharge diagnosis and evaluate possible predictive factors that may influence it. METHODS We retrospectively reviewed the medical records of 192 patients admitted to the ward of the Neurology Department of Centro Hospitalar Universitário São João (CHUSJ), with a discharge diagnosis of ON. Subsequently, we selected those admitted from the ER, with clinical, laboratory and imaging data, between January 2004 and December 2021. RESULTS We included 171 patients. All participants were discharged from the ER and admitted in the ward with a main diagnostic suspicion of ON. Patients were stratified according to suspected etiology at the time of discharge: 99 inflammatory (57.9%), 38 ischemic (22.2%), 27 unspecified (15.8%) and 7 other (4.1%). By comparing with current follow-up diagnosis, 125 patients had an accurate ER diagnosis category (73.1%), 27 had an ON diagnosis of unspecified etiology that was defined only during follow-up (15.8%) and 19 had an inaccurate diagnosis category (11.1%). Diagnostic change was more common with ER ischemic diagnosis (21.1%) compared to inflammatory diagnosis (8.1%) (p = 0.034). CONCLUSIONS Our study reveals that most patients with ON can be accurately diagnosed in the ER through clinical history neurological and ophthalmological evaluation.
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Affiliation(s)
- Daniel Cardoso
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Sofia Bezerra
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ricardo Soares-dos-Reis
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Neurology, Centro Hospitalar de São João (CHUSJ), Porto, Portugal
- i3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Maria José Sá
- Department of Neurology, Centro Hospitalar de São João (CHUSJ), Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - Joana Guimarães
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Neurology, Centro Hospitalar de São João (CHUSJ), Porto, Portugal
- Center for Drug Discovery and Innovative Medicines (MedInUP), University of Porto, Portugal
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Gong HX, Xie SY. Non-arteritic anterior ischemic optic neuropathy combined with branch retinal vein obstruction: A case report. World J Clin Cases 2023; 11:6189-6193. [PMID: 37731577 PMCID: PMC10507569 DOI: 10.12998/wjcc.v11.i26.6189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/16/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Non-arteritic anterior ischemic optic neuropathy (NAION) is an independent disease characterized by edematous optic discs. In eyes with branch retinal vein occlusion (BRVO), the arteries and veins in the ethmoid plate of the optic disc are relatively crowded; however, a combination of the two is clinically uncommon. Herein, we reported a patient with NAION and concealed BRVO, for which the treatment and prognosis were not similar to those for NAION alone. CASE SUMMARY Herein, we report a case of NAION with concealed BRVO that did not improve with oral medication. A week later, we switched to intravenous drug administration to improve circulation, and the patient's visual acuity and visual field recovered. Hormonal therapy was not administered throughout the study. This case suggested that: (1) Fundus fluorescein angiography (FFA) can help detect hidden BRVO along with the NAION diagnosis; (2) intravenous infusion of drugs to improve circulation has positive effects in treating such patients; and (3) NAION with concealed BRVO may not require systemic hormonal therapy, in contrast with the known treatment for simple NAION. CONCLUSION NAION may be associated with hidden BRVO, which can only be observed on FFA; intravenous therapy has proven effectiveness.
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Affiliation(s)
- Hong-Xia Gong
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin 300020, China
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300020, China
- Neuroophthalmology, Nankai University Affiliated Eye Hospital, Tianjin 300020, China
| | - Shi-Yong Xie
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin 300020, China
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300020, China
- Neuroophthalmology, Nankai University Affiliated Eye Hospital, Tianjin 300020, China
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Shahraki K, Najafi A, Ashoori N, Razzaghpour N, Shahraki K. Arteritic Anterior Ischemic Optic Neuropathy (AAION) Associated with COVID-19 Infection: A Case Report and Review of the Literature. Case Rep Ophthalmol Med 2023; 2023:9009925. [PMID: 37492646 PMCID: PMC10365912 DOI: 10.1155/2023/9009925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/27/2023] Open
Abstract
Anterior ischemic optic neuropathy (AION) is the most frequent cause of acute optic nerve damage in the elderly, usually causing acute, unilateral, and painless permanent visual loss. Arteritic anterior ischemic optic neuropathy (AAION) is a result of endothelial cell inflammation and the subsequent thrombosis and occlusion in the blood-supplying arteries of the optic nerve head. AAION accounts only for 5-10% of all AION cases that are associated with vasculitis which usually takes place in the course of a giant cell arteritis (GCA). In this paper, we report a case of AAION following a COVID-19 respiratory infection. Although it is uncertain whether SARS-CoV-2 infection triggered the AAION or was coincidental, the possible association of the events is concerning.
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Affiliation(s)
- Kourosh Shahraki
- Department of Ophthalmology, Alzahra Eye Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Amin Najafi
- Department of Surgery, School of Medicine and Allied Medical Sciences, Imam Reza Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Negin Ashoori
- Department of Surgery, School of Medicine and Allied Medical Sciences, Imam Reza Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Nayyereh Razzaghpour
- Department of Surgery, School of Medicine and Allied Medical Sciences, Imam Reza Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Kianoush Shahraki
- Department of Ophthalmology, Alzahra Eye Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
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Li X, Guo T, Zhang Y, Liu K, Xu X, Fu Y, Liu X, Ren X, Yang H. Risk Factors for Fellow Eye Involvement in Patients with Nonarteritic Anterior Ischemic Optic Neuropathy. Ophthalmic Res 2022; 66:398-405. [PMID: 36502803 DOI: 10.1159/000528627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The aim of the study was to investigate the possible risk factors for fellow eye involvement in patients with nonarteritic anterior ischemic optic neuropathy (NAION). METHODS A total of 113 patients with unilateral NAION attack were included and divided into two groups according to whether fellow eye involvement was present over a mean follow-up period of 2.70 years (P25-P75: 0.77-3.54 years). General characteristics (including age, sex, diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea syndrome [OSAS]) and ocular characteristics (including initial best-corrected visual acuity, initial visual field damage of the first eye, and the presence/absence of a crowded disc) were analyzed and compared between the two groups. Cox regression was used to assess the risk factors for fellow eye involvement. RESULTS During the follow-up period, 40 patients developed fellow eye involvement. The initial best-corrected visual acuity (p = 0.048) and mean deviation of the visual field (VF) (p = 0.039) of the first eye in patients with fellow eye involvement were worse than those in patients without it. Diabetes (HR = 3.06, 95% CI: 1.50, 6.26, p = 0.002) and increased VF damage (moderate vs. mild, HR = 2.92, 95% CI: 1.03, 8.25, p = 0.043; severe vs. mild, HR = 5.01, 95% CI: 1.65, 15.20, p = 0.004) were associated with a significantly increased risk of fellow eye involvement. In 57 patients with apnea-hypopnea index (AHI) data for further study, an AHI score ≥23.2 was also found to be a risk factor (HR = 3.36, 95% CI: 1.17, 9.69, p = 0.025). CONCLUSION Diabetes, severer initial VF damage, and more severe OSAS were risk factors for fellow eye involvement in NAION. For patients with these risk factors, more intensive follow-ups might be warranted.
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Affiliation(s)
- Xinnan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China,
| | - Taimin Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yurong Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Kaiqun Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyu Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yue Fu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoning Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xin Ren
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hui Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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