Ksiaa Imen, Ben Aoun Safa, Zina Sourour, Nefzi Dhouha, Khochtali Sana, Khairallah Moncef
Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 5000, Monastir, Tunisia.
J Ophthalmic Inflamm Infect. 2020 Dec 7;10(1):33. doi: 10.1186/s12348-020-00226-y.
To describe a case of Behçet disease (BD) uveitis manifesting with sequential bilateral neuroretinitis associated with prepapillary inflammatory vitreous exudate (PIVE).
A single case report documented with multimodal imaging.
A 37-year-old man developed neuroretinitis with associated PIVE in the left eye. He was diagnosed with ocular toxoplasmosis and treated accordingly based on positive serologic testing and negative work-up for other entities, including BD. The disease course was favorable, but 1 year later a similar neuroretinitis developed in the right eye. Extraocular features of BD became evident only at the time of the second eye involvement, and the patient received corticosteroid and immunosuppressive therapy. Swept source (SS) OCT showed at the acute phase in both eyes a typical "mushroom-shaped" prepapillary hyperreflectivity of the PIVE. SS OCT angiography (OCTA) demonstrated a corresponding prepapillary hypointense area due to shadowing effect, decreasing in size while scanning deeper layers. It also detected peripapillary retinal hypervascularity in both eyes and a sectoral area of flow signal loss in the first involved left eye. Visual acuity improved following the resolution of the PIVE and associated acute inflammatory changes in both eyes. The left eye showed residual optic disc pallor and retinal nerve fiber layer defects.
Sequential bilateral neuroretinitis associated with PIVE may occur before other clinical features of BD become evident. SS OCT and OCTA can provide useful information for the diagnosis and management of this rare, but typical, ocular manifestation of BD uveitis.
描述一例白塞病（BD）葡萄膜炎，表现为先后发生的双侧神经视网膜炎，并伴有视乳头前炎性玻璃体渗出（PIVE）。
一份通过多模态成像记录的单病例报告。
一名37岁男性左眼出现伴有PIVE的神经视网膜炎。基于血清学检测呈阳性且对包括BD在内的其他疾病的检查结果为阴性，他被诊断为眼弓形虫病并接受了相应治疗。病程发展良好，但1年后右眼出现了类似的神经视网膜炎。仅在第二只眼受累时BD的眼外表现才变得明显，该患者接受了皮质类固醇和免疫抑制治疗。扫频源（SS）光学相干断层扫描（OCT）显示，在急性期双眼PIVE的视乳头前均出现典型的“蘑菇形”高反射。SS OCT血管造影（OCTA）显示，由于遮挡效应，相应的视乳头前低信号区在扫描更深层时尺寸减小。它还检测到双眼视乳头周围视网膜血管增生，以及第一只受累的左眼存在扇形血流信号缺失区。随着双眼PIVE及相关急性炎症改变的消退，视力有所改善。左眼出现了残留的视盘苍白和视网膜神经纤维层缺损。
与PIVE相关的先后双侧神经视网膜炎可能在BD的其他临床特征变得明显之前就已发生。SS OCT和OCTA可为这种罕见但典型的BD葡萄膜炎眼部表现的诊断和治疗提供有用信息。
