Ahmad Meleha, Carey Andrew R, Eberhart Charles G, Siadati Sepideh, Henderson Amanda D
Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA.
J Ophthalmic Inflamm Infect. 2021 Jan 29;11(1):5. doi: 10.1186/s12348-021-00235-5.
A 76-year old African American female with a history of arteritic ischemic optic neuropathy (AION) secondary to biopsy-proven giant cell arteritis (GCA) presented with unilateral vision loss in her contralateral eye despite high-dose oral steroid treatment. Dilated fundus examination revealed three cotton wool spots. Fluorescein angiography showed slowed arteriolar filling with late staining of small peripheral arteries, consistent with small vessel arteritis. Laboratory tests for alternative vasculitides were negative. Review of her temporal artery biopsy specimen confirmed lymphoplasmacytic inflammation around small adventitial vessels with no destructive granulomatous or leukocytoclastic small vessel vasculitis, consistent with GCA. Our unique case demonstrates peripheral small vessel retinal arteriolar leakage in GCA, which is a rare finding. This association is of interest because GCA is commonly associated with medium to large vessel pathology without small vessel involvement.
一名76岁非裔美国女性，有活检证实的巨细胞动脉炎（GCA）继发动脉炎性缺血性视神经病变（AION）病史，尽管接受了高剂量口服类固醇治疗，但对侧眼仍出现单眼视力丧失。散瞳眼底检查发现三个棉絮斑。荧光素血管造影显示小动脉充盈减慢，外周小动脉晚期染色，符合小血管动脉炎表现。其他血管炎的实验室检查结果均为阴性。回顾其颞动脉活检标本，证实小外膜血管周围有淋巴浆细胞炎症，无破坏性肉芽肿或白细胞破碎性小血管血管炎，符合GCA表现。我们这个独特的病例显示了GCA患者外周小血管视网膜小动脉渗漏，这是一个罕见的发现。这种关联很有意思，因为GCA通常与中到大血管病变相关，不累及小血管。
