J Korean Ophthalmol Soc.  2015 Dec;56(12):1979-1984. 10.3341/jkos.2015.56.12.1979.

A Case of Polyarteritis Nodosa with Decreased Vision as a First Symptom

• Kim CZ
• Nam KY
• Lee SJ
• Lee SU

• KMID: 2148765
• DOI: http://doi.org/10.3341/jkos.2015.56.12.1979

Abstract

PURPOSE
Polyarteritis nodosa (PAN) is the necrotic vasculitis affecting middle and small-sized arteries throughout the body including ocular tissue. We report an atypical PAN case of unilateral central retinal artery occlusion in which the ocular involvement occurred before systemic symptoms.
CASE SUMMARY
A 58-year-old male visited the ophthalmology department due to abruptly decreased visual acuity. Best corrected visual acuity (BCVA) was 0.05 (in the right eye) and 1.0 (in the left eye) basedon the Snellen chart. He complained of acute decreased vision occurring ten days prior and intermittent migraine on the right side with no underlying diseases, such as hypertension or diabetes mellitus. Relative afferent pupillary defect was observed in the right eye. Generalized edema was found around the optic disc and fovea on fundus examination and optical coherence tomography. The patient was diagnosed with central retinal artery occlusion (CRAO) based on a fluorescein angiography. Subsequently, PAN was diagnosed based on clinical features, laboratory test results and imaging studies. The treatment was started with an immunosuppressive agent. One month later, the BCVA was 0.05 based on the Snellen chart.
CONCLUSIONS
In PAN patients, decreased vision can occur as a first symptom due to CRAO. If the patient visits the ophthalmology clinic, history taking and laboratory tests for PAN can aid in early diagnosis and treatment, as well as preventing additional complications of PAN.

Keyword

Central retinal artery occlusion; Polyarteritis nodosa

MeSH Terms

Arteries
Diabetes Mellitus
Early Diagnosis
Edema
Fluorescein Angiography
Humans
Hypertension
Male
Middle Aged
Migraine Disorders
Ophthalmology
Polyarteritis Nodosa*
Pupil Disorders
Retinal Artery Occlusion
Tomography, Optical Coherence
Vasculitis
Visual Acuity

Figure

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  Figure 1. Photographs of fundus and optical coherence tomography (OCT). (A) Ischemic change fo the perifovea and posterior pole. (B) It shows cross section line in OCT. (C) The edema of inner retina is seen which is typical sign of central retinal artery occlusion. Each retinal layer is difficult to differentiate. (D) The other fundus of same patient looks like normal. (E) It shows cross ssection line in OCT. (F) The other eye of same patient shows normal retinal layers.retinal layers.

• 

  Figure 2. Fluoroscein angiography. (A) Fluorescein angiography shows delayed arm-to-retina time. (B, C) At early and late phase, hypofluorescent lesions are seen the superior and inferior area of the optic disc.

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  Figure 3. Photographs of fundus and optical coherence tomography (OCT). (A) Relative pale optic disc, but no significant ischemic area is seen. (B) It shows cross section line in OCT. (C) Shows the mildly regressed thickening of the inner retina compared with OCT image taken 1 month ago. Each retinal layer is seen more apparently. (D) The other fundus of same patient looks like normal. (E) It shows cross ssection line in OCT. (F) The other eye of same patient shows normal retinal layers.

Reference

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