Vazquez-Romo Kristian A, Rodriguez-Hernandez Adrian, Paczka Jose A, Nuño-Suarez Moises A, Rocha-Muñoz Alberto D, Zavala-Cerna Maria G
Ophthalmology Department, Hospital Regional "Dr. Valentín Gómez Farías", Zapopan, Jalisco, México.
UIEC, Hospital de Especialidades, Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, México.
Front Neurol. 2017 Sep 20;8:490. doi: 10.3389/fneur.2017.00490. eCollection 2017.
To describe a case of optic neuropathy as a primary manifestation of polyarteritis nodosa (PAN) and discuss diagnostic challenges.
Case report.
A 41-year-old Hispanic man presented with a 2-day history of reduced visual acuity in his left eye. Physical examination revealed a complete visual field loss in the affected eye. Best-corrected visual acuity (BCVA) in the left eye was hand motion, and fundus examination revealed a hyperemic optic disk with blurred margins, swelling, retinal folds, dilated veins, and normal size arteries. BCVA in the right eye was 20/20; no anomalies were seen during examination of the fundus. The patient was started on oral corticosteroids and once the diagnosis of PAN was made, cyclophosphamide was added to the treatment regimen. Six months later, the patient recovered his BCVA to 20/20 in his left eye.
Rarely does optic neuropathy present as a primary manifestation of PAN; nevertheless, it represents an ophthalmologic emergency that requires expeditious anti-inflammatory and immunosuppressive treatment to decrease the probability of permanent visual damage. Unfortunately, diagnosing PAN is challenging as it necessitates a high index of suspicion. In young male patients who present for the first time with diminished visual acuity, ophthalmologists become cornerstones in the suspicion of this diagnosis and should be responsible for continuing the study until a diagnosis is reached to ensure rapid commencement of immunosuppressive treatment.
描述一例以视神经病变为结节性多动脉炎（PAN）主要表现的病例，并探讨诊断挑战。
病例报告。
一名41岁的西班牙裔男性，左眼视力下降2天。体格检查发现患眼完全视野缺损。左眼最佳矫正视力（BCVA）为手动，眼底检查显示视盘充血、边缘模糊、肿胀、视网膜皱褶、静脉扩张，动脉大小正常。右眼BCVA为20/20；眼底检查未见异常。患者开始口服皮质类固醇，一旦确诊为PAN，治疗方案中加入环磷酰胺。6个月后，患者左眼BCVA恢复至20/20。
视神经病变很少作为PAN的主要表现出现；然而，它是一种眼科急症，需要迅速进行抗炎和免疫抑制治疗，以降低永久性视力损害的可能性。不幸的是，诊断PAN具有挑战性，因为它需要高度的怀疑指数。对于首次出现视力下降的年轻男性患者，眼科医生是怀疑该诊断的关键，应负责继续检查直至确诊，以确保迅速开始免疫抑制治疗。
