Clin Mol Hepatol.  2018 Dec;24(4):417-423. 10.3350/cmh.2017.0021.

Bilateral optic neuropathy related to severe anemia in a patient with alcoholic cirrhosis: A case report and review of the literature

• Humbertjean-Selton L
• Selton J
• Riou-Comte N
• Lacour JC
• Mione G
• Richard S

• KMID: 2433307
• DOI: http://doi.org/10.3350/cmh.2017.0021

Abstract

Anemia appears frequently in patients with alcoholic liver disease (ALD) but has never been linked to bilateral nonarteritic anterior ischemic optic neuropathy (NAION). A 65-year-old woman with a medical history of alcoholic cirrhosis was admitted for bilateral NAION. On admission, she was found to have a low arterial pressure and severe normocytic anemia (48 g/L). The anemia was related to chronic bleeding due to antral gastritis along with other factors associated with ALD. The applied treatment consisted of urgent transfusion followed by high doses of proton-pump inhibitors, iron and vitamin supplementation, and support in lifestyle measures. Her hemoglobin levels remained stable after 2 years but the patient still suffered from visual loss. This case highlights the link between anemia and bilateral NAION in ALD patients. The optic nerve head is prone to infarction in this context due to the vascularization characteristics of ALD. Hemoglobin levels should be monitored in ALD patients to avoid the severe complication of NAION.

Keyword

Alcoholic liver disease; Alcoholic cirrhosis; Chronic alcohol consumption; Anemia; Nonarteritic anterior ischemic optic neuropathy

MeSH Terms

Aged
Alcoholics*
Anemia*
Arterial Pressure
Female
Gastritis
Hemorrhage
Humans
Infarction
Iron
Life Style
Liver Cirrhosis, Alcoholic*
Liver Diseases, Alcoholic
Optic Disk
Optic Nerve Diseases*
Optic Neuropathy, Ischemic
Vitamins
Iron
Vitamins