Posters

Simultaneous presentation of four different ocular manifestations of Wegener's granulomatosis in one eye: a case report

Poster Details

First Author: A. Salehi IRAN, ISLAMIC REPUBLIC OF

Co Author(s):                        

Abstract Details

Purpose:

To report a patient of Wegener's granulomatosis (WG) with four manifestations that occurred in one eye at limit period of time. Case: A 42-year-old male patient following WG was referred to emergent room for his sudden blurred vision four hour before referring. Eye examination showed hyperemic conjunctiva due to necrotizing scleritis in superonasal quadrant of left eye and left superior lid mass as well as central retinal artery occlusion in the same eye. Conclusions: This case suggests that the unilateral eye involvement may be the prominent manifestation of an underlying WG disease.

Setting:

WG Ocular manifestationsin the most of patients include conjunctivitis, episcleritis, peripheral ulcerative keratitis, scleritis, uveitis, choroiditis, and central retinal artery occlusion. Corneal, nasolacrimal, optic nerve, uveal, retinal, conjunctival involment have been reported in few cases. Visual loss in WG may result from choroidal, retinal, or optic nerve involvement.

Methods:

Case Report A 42-year-old man presented to IRAN ISFAHAN Feiz Eye Hospital for the treatment of his sudden persistent painless loss of vision in April 2013. He had history of WG since 10 months with stablished kidney involvement.

Results:

Diagnosis of Wegeners was made as per American Rheumatology Criteria.1 included complete blood count , erythrocyte sedimentation rate , C-reactive protein , Chest X-Ray, urine analysis, C-ANCA detection. The patient gradually was improved until that he referred to our hospital with severe visual loss in left eye that occurred 2 hours ago. The patient described a sudden black spot in his vision that spread out over his complete left visual field over 1 minute time frame. He had severe headache, left eye redness and pain since some days ago, after tapering prednisone dose.Dilated fundoscopy of the left eye demonstrated a 'cherry-red spot' at the macula with edematous retina, characteristic of CRAO.

Conclusions:

What initially appeared to be important in this case is that CRAO and eyelid involvement are uncommon manifestation of retinal vasculitis due to WG . Althogh necrotizing scleritis often seen as a common ocular manifestation in WG but well-documented cases of CRAO in WG have been rarely reported. Especially, our patient had an atypical presentation considering that he had signs of all three rare ophthalmic manifestations only occurred together in one eye in a limit period of time.

Financial Disclosure:

NONE