RESUMO
Purpose: To report a pediatric case of optic neuritis with subsequent development of central retinal vein occlusion (CRVO). Methods: A case and its findings were analyzed. Results: A 16-year-old boy presented with painful vision loss in the left eye, an afferent pupillary defect, and optic disc edema. Magnetic resonance imaging showed optic nerve enhancement and contrast-enhancing cerebral white-matter lesions, consistent with optic neuritis and demyelinating disease. He received intravenous methylprednisolone followed by a prednisone taper. At the 3-week follow-up, the visual acuity (VA) in the left eye had worsened and fundoscopic examination showed a new CRVO. A hypercoagulable workup showed antiphospholipid syndrome, which was treated with warfarin. He received intravitreal antivascular endothelial growth factor treatment with subsequent improvement in VA and resolution of the macular edema. Conclusions: This case describes an unusual mechanism for CRVO via a combination of optic disc edema from optic neuritis and hypercoagulability from antiphospholipid syndrome. It is important to recognize this complication of optic disc edema and the necessary workup for a pediatric CRVO.
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A 41-year-old man presented to the emergency department with a painful and red left eye associated with chronic vision loss. He had a history of homelessness and polysubstance abuse including intravenous drug use. Fundus examination revealed several cream-colored lesions encroaching on the macula of the right eye, and a total retinal detachment with secondary neovascular glaucoma in the left eye. Further work-up with imaging and endobronchial ultrasound-guided fine needle aspiration revealed stage IV epidermal growth factor receptor (EGFR) mu- tant (L858R) lung adenocarcinoma with brain, bone, adrenal, lymph node and bilateral choroid- al metastases. Herein we present a case of metastatic lung cancer masquerading as endophthalmitis.
Assuntos
Adenocarcinoma/patologia , Neoplasias Oculares/secundário , Neoplasias Pulmonares/patologia , Metástase Neoplásica/diagnóstico por imagem , Adenocarcinoma/genética , Adulto , Diagnóstico Diferencial , Endoftalmite , Receptores ErbB/genética , Neoplasias Oculares/fisiopatologia , Humanos , Neoplasias Pulmonares/genética , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: Neonatal-onset Multisystem Inflammatory Disorder (NOMID) is a systemic syndrome characterized by rash, large joint osteoarthropathies and chronic meningitis. Ocular manifestations include optic disc edema, corneal opacities and uveitis. We report the novel finding of serous retinal detachments (RD) in NOMID. METHODS: Case report. RESULTS: An eight-month-old girl was referred to the ED for work-up of optic disc edema. Physical exam revealed flat fontanelles; macrocephaly and frontal bossing; diffuse urticarial rash; and swollen joints; WBC count and inflammatory markers were elevated. Ophthalmology exam revealed decreased visual acuity, optic disc edema and bilateral serous RD. MRI revealed bilateral enhancement of the ocular choroid and enlargement of the third and fourth ventricles secondary to aqueductal webbing. After infectious testing returned negative, the patient was treated with anakinra, an interleukin-1 receptor antagonist. Three months later, the serous RDs resolved. CONCLUSION: Physicians should consider NOMID in infants presenting with diffuse rash, bilateral disc edema and serous retinal detachments.
Assuntos
Síndromes Periódicas Associadas à Criopirina/complicações , Papiledema/etiologia , Descolamento Retiniano/etiologia , Uveíte/etiologia , Feminino , Humanos , Lactente , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Imageamento por Ressonância Magnética , Papiledema/tratamento farmacológico , Receptores de Interleucina-1/antagonistas & inibidores , Descolamento Retiniano/tratamento farmacológico , Uveíte/tratamento farmacológico , Acuidade VisualRESUMO
[Full article available at http://rimed.org/rimedicaljournal-2019-02.asp].
Assuntos
Coriorretinite/diagnóstico por imagem , Eletrorretinografia , Uveíte/diagnóstico por imagem , Uveíte/etiologia , Acuidade Visual/fisiologia , Idoso , Coriorretinopatia de Birdshot , Coriorretinite/fisiopatologia , Angiofluoresceinografia , Antígenos HLA-A , Humanos , Masculino , Uveíte/fisiopatologia , Conduta ExpectanteRESUMO
We present the novel finding of retinal astrocytoma in a 15-year-old boy with phosphatase and tensin homologue hamartoma tumor syndrome, confirmed by genetic testing.
Assuntos
Astrocitoma/diagnóstico por imagem , Hamartoma/diagnóstico por imagem , Doenças Retinianas/diagnóstico por imagem , Adolescente , Astrocitoma/complicações , Hamartoma/genética , Humanos , Masculino , Mutação/genética , PTEN Fosfo-Hidrolase/genética , Doenças Retinianas/genética , Neoplasias da Retina/complicações , Neoplasias da Retina/diagnóstico por imagem , SíndromeAssuntos
Infecções Oculares Bacterianas/microbiologia , Mycoplasma pneumoniae/isolamento & purificação , Papiledema/microbiologia , Pneumonia por Mycoplasma/microbiologia , Uveíte/microbiologia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/sangue , Azitromicina/uso terapêutico , Diagnóstico Diferencial , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Feminino , Angiofluoresceinografia , Glucocorticoides/uso terapêutico , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Mycoplasma pneumoniae/imunologia , Papiledema/diagnóstico , Papiledema/tratamento farmacológico , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/tratamento farmacológico , Prednisona/uso terapêutico , Tomografia de Coerência Óptica , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Adulto JovemRESUMO
A 31-year-old woman with morning glory optic disc anomaly (MGDA) developed acute retrobulbar optic neuritis and a bullous macular detachment. MRI demonstrated truncation of the perineural space of the affected optic nerve as well as focal optic nerve enhancement. Optical coherence tomography (OCT) showed retinoschisis associated with the macular detachment. The MRI and OCT findings support the vitreous as the source of the subretinal fluid. This is the first reported case of optic neuritis in MGDA.
