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[以缺血性视神经病变为表现的嗜酸性肉芽肿性多血管炎]

[Eosinophilic granulomatosis with polyangiitis presenting with ischemic optic neuropathy].

作者信息

Imanaka Shohei, Komatsu Kenichi, Oka Yuwa, Takahashi Makio

机构信息

Department of Neurology, Kitano Hospital, Tazuke Kofukai Medical Research Institute.

出版信息

Rinsho Shinkeigaku. 2022 Jun 24;62(6):481-486. doi: 10.5692/clinicalneurol.cn-001732. Epub 2022 May 28.

Abstract

A 60-year-old man with a history of bronchial asthma and nasal polyp presented with loss of vision in the right eye. His visual loss progressed within a single day, and he presented to our hospital 5 days after the onset of the symptom. Fundoscopy showed swelling and hemorrhage of the right optic disc. Blood tests revealed increased eosinophils, C-reactive protein, and perinuclear anti-neutrophil cytoplasmic antibody. Cerebrospinal fluid was normal. Cranial MRI showed local enhancement of the right optic disc and posterior ciliary arteries. He was diagnosed with arteritic anterior ischemic optic neuropathy caused by eosinophilic granulomatosis with polyangiitis (EGPA). High dose intravenous methylprednisolone was started on presentation, but the patient showed no improvement in visual function. Although a rare complication, ischemic optic neuropathy associated with EGPA should be noted, as this is an emergent condition and requires prompt diagnosis and treatment.

摘要

一名60岁男性,有支气管哮喘和鼻息肉病史,出现右眼视力丧失。其视力丧失在一天内进展,症状出现5天后到我院就诊。眼底检查显示右侧视盘肿胀和出血。血液检查显示嗜酸性粒细胞、C反应蛋白和核周抗中性粒细胞胞浆抗体增加。脑脊液正常。头颅MRI显示右侧视盘和睫状后动脉局部强化。他被诊断为嗜酸性肉芽肿性多血管炎(EGPA)引起的动脉炎性前部缺血性视神经病变。就诊时开始大剂量静脉注射甲基泼尼松龙,但患者视觉功能无改善。尽管是罕见并发症,但与EGPA相关的缺血性视神经病变应引起注意,因为这是一种紧急情况,需要及时诊断和治疗。

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