Bair Henry, Lin Chun-Ju, Li You-Ling, Hsia Ning-Yi, Lai Chun-Ting, Lin Jane-Ming, Chen Wen-Lu, Chiang Chun-Chi, Tsai Yi-Yu
Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.
Stanford University School of Medicine, Stanford, CA, USA.
Am J Ophthalmol Case Rep. 2022 Feb 18;26:101437. doi: 10.1016/j.ajoc.2022.101437. eCollection 2022 Jun.
We report a male who presented with acute visual defect and was diagnosed with urticarial vasculitis with recurrent branch retinal artery occlusion (BRAO) after systemic disease survey, fluorescein angiography (FA), and MultiColor imaging (MCI).
A 47-year-old male with a history of urticarial vasculitis presented with visual defect OD. Fundus examination showed two foci of ischemic retinal whitening beneath the inferior arcade and above the superior arcade. MCI demonstrated a greenish tinge in the corresponding area. FA revealed segmental arteriolar staining and arterial occlusive changes. BRAO with retinal arteritis was diagnosed. Toxoplasma IgG was positive. Sulfamethoxazole 400mg plus trimethoprim 80mg was given. His vision worsened after 1-week of treatment. The established lesions improved, but new lesions occurred. Interferon-gamma release assay was positive but tuberculosis DNA qualitative amplification test of sputum was negative. Sputum acid-fast stain was positive and culture revealed nontuberculous mycobacteria. Left facial itching and reactive lymphadenopathy developed. Prednisolone and cyclophosphamide were started. The initial retinal artery lesions regained perfusion.
Urticarial vasculitis with recurrent BRAO is an immune complex-mediated disease. Greenish-tinged occlusive lesions were noted from MCI with high resolution and contrast. MCI could be a valuable method for retinal vessel occlusive disease detection before FA and follow up.
我们报告了一名男性患者，其出现急性视力缺陷，经全身疾病检查、荧光素血管造影（FA）和多色成像（MCI）后，被诊断为伴有复发性视网膜分支动脉阻塞（BRAO）的荨麻疹性血管炎。
一名有荨麻疹性血管炎病史的47岁男性，出现右眼视力缺陷。眼底检查显示在下方视网膜弓状缘下方和上方视网膜有两个缺血性视网膜变白病灶。MCI显示相应区域有绿色色调。FA显示节段性小动脉染色和动脉阻塞性改变。诊断为伴有视网膜动脉炎的BRAO。弓形虫IgG呈阳性。给予磺胺甲恶唑400mg加甲氧苄啶80mg。治疗1周后他的视力恶化。已有的病灶有所改善，但出现了新的病灶。干扰素-γ释放试验呈阳性，但痰结核DNA定性扩增试验为阴性。痰抗酸染色呈阳性，培养显示为非结核分枝杆菌。出现左侧面部瘙痒和反应性淋巴结病。开始使用泼尼松龙和环磷酰胺。最初的视网膜动脉病灶恢复了灌注。
伴有复发性BRAO的荨麻疹性血管炎是一种免疫复合物介导的疾病。通过高分辨率和对比度的MCI可观察到绿色调的阻塞性病变。MCI可能是在FA之前检测视网膜血管阻塞性疾病及进行随访的一种有价值的方法。
