Toxic retrobulbar neuritis due to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-based chronic sinusitis in the left sphenoid sinus: a case report
Abstract Background Abrupt visual impairment constitutes a medical urgency, necessitating an interdisciplinary diagnostic and therapeutic approach owing to the broad spectrum of potential etiologies, thereby engaging numerous medical specialties. Case presentation A 21-year-old Mixed White and Asian...
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-023-04060-3 |
| _version_ | 1797752725245526016 |
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| author | Mirco Schapher Jacob Bruegel Fabian Guener Bastian Volbers Philip Eichhorn Abbas Agaimy Magdalena Berger Christian Mardin Arnd Doerfler Stefan W. Hock |
| author_facet | Mirco Schapher Jacob Bruegel Fabian Guener Bastian Volbers Philip Eichhorn Abbas Agaimy Magdalena Berger Christian Mardin Arnd Doerfler Stefan W. Hock |
| author_sort | Mirco Schapher |
| collection | DOAJ |
| description | Abstract Background Abrupt visual impairment constitutes a medical urgency, necessitating an interdisciplinary diagnostic and therapeutic approach owing to the broad spectrum of potential etiologies, thereby engaging numerous medical specialties. Case presentation A 21-year-old Mixed White and Asian female patient, with medical history of nonsteroidal antiinflammatory drug-exacerbated respiratory disease necessitating previous sinus surgery, reported sudden monocular vision loss. Unremarkable ophthalmological examination of the fellow eye and hematological parameters, save for a slight elevation in lymphocytes and eosinophils, were observed. Imaging studies indicated recurrence of bilateral chronic rhinosinusitis with nasal polyps and a mucocele in the left sphenoid sinus, accompanied by bony structural deficits. Emergency revision sinus surgery, guided by navigation, was promptly performed. The patient received treatment with methylprednisolone, ceftriaxone, cyanocobalamin, pyridoxine, thiamine, and acetylsalicylic acid. During the hospital stay, she developed steroid-induced glaucoma, which was subsequently managed successfully. Negative microbiological swabs, along with pathohistological evidence of increased tissue eosinophilia and the patient’s clinical history, led to the diagnosis of toxic retrobulbar neuritis secondary to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-associated chronic rhinosinusitis of the left sphenoid sinus. Conclusions In cases of acute unilateral vision loss, optic neuritis is a highly probable differential diagnosis and may be induced by pathologies of the paranasal sinuses. Nonsteroidal antiinflammatory drug-exacerbated respiratory disease, a subtype of chronic rhinosinusitis, is associated with type 2 inflammation, which is increasingly recognized for its role in the pathogenesis of bronchial asthma, eosinophilic esophagitis, and atopic eczema. Clinicians should consider chronic rhinosinusitis as a potential differential diagnosis in unilateral visual loss and be cognizant of the rising significance of type 2 inflammations, which are relevant to a variety of diseases. |
| first_indexed | 2024-03-12T17:08:40Z |
| format | Article |
| id | doaj.art-d7ea962ee8b849d4ba9a0c41d75d84f4 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-03-12T17:08:40Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-d7ea962ee8b849d4ba9a0c41d75d84f42023-08-06T11:15:43ZengBMCJournal of Medical Case Reports1752-19472023-08-011711610.1186/s13256-023-04060-3Toxic retrobulbar neuritis due to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-based chronic sinusitis in the left sphenoid sinus: a case reportMirco Schapher0Jacob Bruegel1Fabian Guener2Bastian Volbers3Philip Eichhorn4Abbas Agaimy5Magdalena Berger6Christian Mardin7Arnd Doerfler8Stefan W. Hock9Department of Otorhinolaryngology–Head and Neck Surgery, Erlangen University Hospital, University of Erlangen–NurembergDepartment of Otorhinolaryngology–Head and Neck Surgery, Erlangen University Hospital, University of Erlangen–NurembergDepartment of Neurology, Erlangen University Hospital, University of Erlangen–NurembergDepartment of Neurology, Erlangen University Hospital, University of Erlangen–NurembergDepartment of Pathology, Erlangen University Hospital, University of Erlangen–NurembergDepartment of Pathology, Erlangen University Hospital, University of Erlangen–NurembergDepartment of Ophthalmology, Erlangen University Hospital, University of Erlangen–NurembergDepartment of Ophthalmology, Erlangen University Hospital, University of Erlangen–NurembergDepartment of Neuroradiology, Erlangen University Hospital, University of Erlangen–NurembergDepartment of Neuroradiology, Erlangen University Hospital, University of Erlangen–NurembergAbstract Background Abrupt visual impairment constitutes a medical urgency, necessitating an interdisciplinary diagnostic and therapeutic approach owing to the broad spectrum of potential etiologies, thereby engaging numerous medical specialties. Case presentation A 21-year-old Mixed White and Asian female patient, with medical history of nonsteroidal antiinflammatory drug-exacerbated respiratory disease necessitating previous sinus surgery, reported sudden monocular vision loss. Unremarkable ophthalmological examination of the fellow eye and hematological parameters, save for a slight elevation in lymphocytes and eosinophils, were observed. Imaging studies indicated recurrence of bilateral chronic rhinosinusitis with nasal polyps and a mucocele in the left sphenoid sinus, accompanied by bony structural deficits. Emergency revision sinus surgery, guided by navigation, was promptly performed. The patient received treatment with methylprednisolone, ceftriaxone, cyanocobalamin, pyridoxine, thiamine, and acetylsalicylic acid. During the hospital stay, she developed steroid-induced glaucoma, which was subsequently managed successfully. Negative microbiological swabs, along with pathohistological evidence of increased tissue eosinophilia and the patient’s clinical history, led to the diagnosis of toxic retrobulbar neuritis secondary to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-associated chronic rhinosinusitis of the left sphenoid sinus. Conclusions In cases of acute unilateral vision loss, optic neuritis is a highly probable differential diagnosis and may be induced by pathologies of the paranasal sinuses. Nonsteroidal antiinflammatory drug-exacerbated respiratory disease, a subtype of chronic rhinosinusitis, is associated with type 2 inflammation, which is increasingly recognized for its role in the pathogenesis of bronchial asthma, eosinophilic esophagitis, and atopic eczema. Clinicians should consider chronic rhinosinusitis as a potential differential diagnosis in unilateral visual loss and be cognizant of the rising significance of type 2 inflammations, which are relevant to a variety of diseases.https://doi.org/10.1186/s13256-023-04060-3Case reportSinusitisBlindnessInflammation mediatorsOpticNeuritis |
| spellingShingle | Mirco Schapher Jacob Bruegel Fabian Guener Bastian Volbers Philip Eichhorn Abbas Agaimy Magdalena Berger Christian Mardin Arnd Doerfler Stefan W. Hock Toxic retrobulbar neuritis due to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-based chronic sinusitis in the left sphenoid sinus: a case report Journal of Medical Case Reports Case report Sinusitis Blindness Inflammation mediators Optic Neuritis |
| title | Toxic retrobulbar neuritis due to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-based chronic sinusitis in the left sphenoid sinus: a case report |
| title_full | Toxic retrobulbar neuritis due to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-based chronic sinusitis in the left sphenoid sinus: a case report |
| title_fullStr | Toxic retrobulbar neuritis due to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-based chronic sinusitis in the left sphenoid sinus: a case report |
| title_full_unstemmed | Toxic retrobulbar neuritis due to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-based chronic sinusitis in the left sphenoid sinus: a case report |
| title_short | Toxic retrobulbar neuritis due to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-based chronic sinusitis in the left sphenoid sinus: a case report |
| title_sort | toxic retrobulbar neuritis due to recurrent nonsteroidal antiinflammatory drug exacerbated respiratory disease based chronic sinusitis in the left sphenoid sinus a case report |
| topic | Case report Sinusitis Blindness Inflammation mediators Optic Neuritis |
| url | https://doi.org/10.1186/s13256-023-04060-3 |
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