RESUMO
BACKGROUND: Orbital metastasis is a possible complication of small cell lung cancer and a pattern of bilateral invasion of the extraocular muscles has rarely been reported in literature. CASE PRESENTATION: A 46-year-old white male with a past medical history of smoking and stage IV small cell lung carcinoma presented with loss of vision and pain in the left eye. Examination revealed bilateral proptosis and left afferent pupillary defect, and visual acuity was hand motion on the left eye and 4/10 on the right eye. An orbital computed tomography scan showed a compression of the left optic nerve between the extraocular muscles at the apex, and a lateral canthotomy was performed for a new-onset compressive optic neuropathy, with residual visual improvement. There was also significant enlargement of the extraocular muscles in the right orbit. The patient was maintained in palliative treatment with both chemotherapy and local medical and surgical (amniotic membrane cover for exposure keratopathy) ophthalmological treatments until he eventually died 5 months after. CONCLUSION: Bilateral metastasis to the extraocular muscles is a very rare manifestation of small cell lung cancer and the palliative treatment in these cases is challenging.
Assuntos
Neoplasias Pulmonares , Músculos Oculomotores , Carcinoma de Pequenas Células do Pulmão , Humanos , Masculino , Pessoa de Meia-Idade , Evolução Fatal , Neoplasias Pulmonares/patologia , Músculos Oculomotores/patologia , Músculos Oculomotores/diagnóstico por imagem , Neoplasias Orbitárias/secundário , Neoplasias Orbitárias/cirurgia , Neoplasias Orbitárias/diagnóstico por imagem , Cuidados Paliativos , Carcinoma de Pequenas Células do Pulmão/patologia , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To report a case of acute macular neuroretinopathy (AMN) following SARS-CoV-2 vaccination. METHODS: Case report. RESULTS: An otherwise healthy 28-year-old white woman presented to an ophthalmology department with complaints of black paracentral vision scotomata on both eyes that appeared 2 days after receiving the first dose of Vaxzevria vaccine. Fundus examination revealed bilateral red brown petaloid lesions around the fovea. On spectral domain optical coherence tomography, a hyperreflective plaque between the outer plexiform and outer nuclear layers along with disruption of ellipsoid zone/interdigitation zone was observed. A diagnosis of AMN was made. CONCLUSION: AMN may be an extremely rare adverse event of SARS-COV-2 vaccination, especially in patients with other risk factors. SYNOPSIS: An otherwise healthy 28-year-old white woman was diagnosed with AMN 2 days after SARS-CoV-2 vaccination.