Impending central retinal vein occlusion in patient with idiopathic cutaneous leukocytoclastic vasculitis
Purpose: To report a case of impending central retinal vein occlusion (CRVO) associated with idiopathic cutaneous leukocytoclastic vasculitis (LCV) that demonstrated significant resolution following treatment with intravenous (IV) methylprednisolone. Observations: A 27-year-old man presented to a te...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-12-01
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| Series: | American Journal of Ophthalmology Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993620302498 |
| _version_ | 1819061647166144512 |
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| author | Amir Akhavanrezayat Doan Luong Hien Brandon H. Pham Huy Vu Nguyen Than Trong Tuong Ngoc Ahmad Al-Moujahed Gunay Uludag Samendra Karkhur Huy Luong Doan Quan Dong Nguyen |
| author_facet | Amir Akhavanrezayat Doan Luong Hien Brandon H. Pham Huy Vu Nguyen Than Trong Tuong Ngoc Ahmad Al-Moujahed Gunay Uludag Samendra Karkhur Huy Luong Doan Quan Dong Nguyen |
| author_sort | Amir Akhavanrezayat |
| collection | DOAJ |
| description | Purpose: To report a case of impending central retinal vein occlusion (CRVO) associated with idiopathic cutaneous leukocytoclastic vasculitis (LCV) that demonstrated significant resolution following treatment with intravenous (IV) methylprednisolone. Observations: A 27-year-old man presented to a tertiary Uveitis Clinic with a five-day history of blurry vision in the right eye (OD). He had a history of a purpuric rash and arthralgias five years ago and a biopsy-confirmed diagnosis of LCV controlled with colchicine two years ago in India. Recently, he presented with a recurrent rash and severe abdominal pain. After being evaluated by rheumatology and gastroenterology, he was placed on Helicobacter pylori treatment and high dose oral prednisone, which improved his skin and gastrointestinal symptoms. At the first ophthalmic exam, his systemic findings included lower extremity purpura. His best-corrected visual acuity (BCVA) was 20/20 in both eyes (OU). Slit-lamp examination revealed no cells or flare in OU. Dilated fundus exam showed mild enlarged, tortuous veins, optic nerve hemorrhage, and intraretinal hemorrhages temporal to the macula in OD. Spectral-domain optical coherence tomography (SD-OCT) demonstrated multiple hyper-reflective, plaque-like lesions involving the inner nuclear layer, consistent with paracentral acute middle maculopathy (PAMM). The patient was diagnosed with impending central retinal vein occlusion (CRVO) in OD. Laboratory evaluations were unremarkable. Aspirin was initially started for the patient but was later held due to the worsening of retinal hemorrhage and retinal vein tortuosity at the one-week follow-up. The patient then received three doses of intravenous methylprednisolone, followed by systemic oral prednisone and mycophenolate mofetil. One month later, retinal hemorrhages, venous stasis, and skin manifestations resolved. Conclusion and importance: Ocular involvement in LCV is rare and may present with different manifestations. The index case is the first report of impending CRVO in a patient with idiopathic LCV and without any other known risk factors for CRVO. Our report not only describes the unique course of LCV-related ocular involvement, but also introduces and underscores a potentially effective therapeutic plan. |
| first_indexed | 2024-12-21T14:46:12Z |
| format | Article |
| id | doaj.art-8e91afd4c33d4b4890ef79afc31e680c |
| institution | Directory Open Access Journal |
| issn | 2451-9936 |
| language | English |
| last_indexed | 2024-12-21T14:46:12Z |
| publishDate | 2020-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj.art-8e91afd4c33d4b4890ef79afc31e680c2022-12-21T19:00:01ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362020-12-0120100934Impending central retinal vein occlusion in patient with idiopathic cutaneous leukocytoclastic vasculitisAmir Akhavanrezayat0Doan Luong Hien1Brandon H. Pham2Huy Vu Nguyen3Than Trong Tuong Ngoc4Ahmad Al-Moujahed5Gunay Uludag6Samendra Karkhur7Huy Luong Doan8Quan Dong Nguyen9Byers Eye Institute, Stanford University, Palo Alto, CA, USAByers Eye Institute, Stanford University, Palo Alto, CA, USA; Pham Ngoc Thach University of Medicine, Saigon, Viet NamByers Eye Institute, Stanford University, Palo Alto, CA, USAByers Eye Institute, Stanford University, Palo Alto, CA, USAByers Eye Institute, Stanford University, Palo Alto, CA, USA; Pham Ngoc Thach University of Medicine, Saigon, Viet NamByers Eye Institute, Stanford University, Palo Alto, CA, USAByers Eye Institute, Stanford University, Palo Alto, CA, USADepartment of Ophthalmology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, IndiaKansas City University of Medicine and Biosciences, Kansas City, MO, USAByers Eye Institute, Stanford University, Palo Alto, CA, USA; Corresponding author. Spencer Center for Vision Research, Byers Eye Institute at Stanford University, 2452 Watson Court Suite 200, Palo Alto, CA, 94303, USA.Purpose: To report a case of impending central retinal vein occlusion (CRVO) associated with idiopathic cutaneous leukocytoclastic vasculitis (LCV) that demonstrated significant resolution following treatment with intravenous (IV) methylprednisolone. Observations: A 27-year-old man presented to a tertiary Uveitis Clinic with a five-day history of blurry vision in the right eye (OD). He had a history of a purpuric rash and arthralgias five years ago and a biopsy-confirmed diagnosis of LCV controlled with colchicine two years ago in India. Recently, he presented with a recurrent rash and severe abdominal pain. After being evaluated by rheumatology and gastroenterology, he was placed on Helicobacter pylori treatment and high dose oral prednisone, which improved his skin and gastrointestinal symptoms. At the first ophthalmic exam, his systemic findings included lower extremity purpura. His best-corrected visual acuity (BCVA) was 20/20 in both eyes (OU). Slit-lamp examination revealed no cells or flare in OU. Dilated fundus exam showed mild enlarged, tortuous veins, optic nerve hemorrhage, and intraretinal hemorrhages temporal to the macula in OD. Spectral-domain optical coherence tomography (SD-OCT) demonstrated multiple hyper-reflective, plaque-like lesions involving the inner nuclear layer, consistent with paracentral acute middle maculopathy (PAMM). The patient was diagnosed with impending central retinal vein occlusion (CRVO) in OD. Laboratory evaluations were unremarkable. Aspirin was initially started for the patient but was later held due to the worsening of retinal hemorrhage and retinal vein tortuosity at the one-week follow-up. The patient then received three doses of intravenous methylprednisolone, followed by systemic oral prednisone and mycophenolate mofetil. One month later, retinal hemorrhages, venous stasis, and skin manifestations resolved. Conclusion and importance: Ocular involvement in LCV is rare and may present with different manifestations. The index case is the first report of impending CRVO in a patient with idiopathic LCV and without any other known risk factors for CRVO. Our report not only describes the unique course of LCV-related ocular involvement, but also introduces and underscores a potentially effective therapeutic plan.http://www.sciencedirect.com/science/article/pii/S2451993620302498Impending central retinal vein occlusionIdiopathic leukocytoclastic vasculitisCutaneous leukocytoclastic angiitisCutaneous small-vessel vasculitisHypersensitivity vasculitisIntravenous methylprednisolone |
| spellingShingle | Amir Akhavanrezayat Doan Luong Hien Brandon H. Pham Huy Vu Nguyen Than Trong Tuong Ngoc Ahmad Al-Moujahed Gunay Uludag Samendra Karkhur Huy Luong Doan Quan Dong Nguyen Impending central retinal vein occlusion in patient with idiopathic cutaneous leukocytoclastic vasculitis American Journal of Ophthalmology Case Reports Impending central retinal vein occlusion Idiopathic leukocytoclastic vasculitis Cutaneous leukocytoclastic angiitis Cutaneous small-vessel vasculitis Hypersensitivity vasculitis Intravenous methylprednisolone |
| title | Impending central retinal vein occlusion in patient with idiopathic cutaneous leukocytoclastic vasculitis |
| title_full | Impending central retinal vein occlusion in patient with idiopathic cutaneous leukocytoclastic vasculitis |
| title_fullStr | Impending central retinal vein occlusion in patient with idiopathic cutaneous leukocytoclastic vasculitis |
| title_full_unstemmed | Impending central retinal vein occlusion in patient with idiopathic cutaneous leukocytoclastic vasculitis |
| title_short | Impending central retinal vein occlusion in patient with idiopathic cutaneous leukocytoclastic vasculitis |
| title_sort | impending central retinal vein occlusion in patient with idiopathic cutaneous leukocytoclastic vasculitis |
| topic | Impending central retinal vein occlusion Idiopathic leukocytoclastic vasculitis Cutaneous leukocytoclastic angiitis Cutaneous small-vessel vasculitis Hypersensitivity vasculitis Intravenous methylprednisolone |
| url | http://www.sciencedirect.com/science/article/pii/S2451993620302498 |
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