Department of Ophthalmology, University Clinical Hospital of Valladolid, Valladolid, Spain.
Department of Ophthalmology, St. Thomas' Hospital, London SE1 7EH, UK.
Rom J Ophthalmol. 2022 Apr-Jun;66(2):193-197. doi: 10.22336/rjo.2022.38.
Sarcoidosis is a chronic multisystemic disease, which can be rarely associated with autoimmune disorders, such as antiphospholipid syndrome (APS). Although amaurosis fugax is an uncommon complication, its presentation can unmask a carotid artery dissection (CAD) in these diseases. In addition, central serous chorioretinopathy (CSC) has been related to vascular disorders too. We presented a case of a Caucasian middle-aged man, who developed CAD symptoms, such as amaurosis fugax in the right eye (RE) and headache. His medical history included arterial hypertension, hypothyroidism, and Lofgren's syndrome. On examination, retinal pigment epithelium (RPE) atrophy and subretinal fluid (SRF) in the macular area of the RE were observed. These findings were confirmed by optical coherence tomography (OCT), which also revealed an increase in choroidal thickness. However, these differed significantly from the contralateral eye. These clinical symptoms and imaging findings suggested a CSC in the RE, but not all clinical processes were justified. Subsequently, a CT angiography was performed and confirmed a significant occlusion in the right internal carotid artery and progressive sharpening of the lumen with an intimal flap due to a carotid dissection. In addition, the laboratory results were compatible with antiphospholipid syndrome (APS). To the authors' knowledge, the patient returned to the ED due to an anterior uveitis and he is currently asymptomatic with Cemidon and Adalimumab treatment. We described for the first time a case of carotid dissection and central serous chorioretinopathy in the context of two autoimmune-based pathologies, such as sarcoidosis and antiphospholipid syndrome. APS = Antiphospholipid syndrome, BCVA = Best-corrected visual acuity, CAD = Carotid artery dissection, CNV = Choroidal neovascular membrane, CSC = Central serous chorioretinopathy, CT = Computed tomography, ED = Emergency Department, ICAD = Internal carotid artery dissection, LE = Left eye, OCT = Optical coherence tomography, RAPD = Relative afferent pupillary defect, RPE = Retinal pigment epithelium, RE = Right eye, SRF = Subretinal fluid.
结节病是一种慢性多系统疾病，可罕见地与自身免疫性疾病相关，如抗磷脂综合征（APS）。尽管一过性黑矇是一种不常见的并发症，但它的出现可能会在这些疾病中揭示颈动脉夹层（CAD）。此外，中心性浆液性脉络膜视网膜病变（CSC）也与血管疾病有关。我们报告了一例高加索中年男性，他出现了 CAD 症状，如右眼（RE）一过性黑矇和头痛。他的病史包括动脉高血压、甲状腺功能减退症和洛夫格伦综合征。检查发现右眼视网膜色素上皮（RPE）萎缩和黄斑区视网膜下积液（SRF）。这些发现通过光学相干断层扫描（OCT）得到证实，OCT 还显示脉络膜厚度增加。然而，这些与对侧眼有显著差异。这些临床症状和影像学发现提示右眼 CSC，但并非所有临床过程都合理。随后进行了 CT 血管造影，证实右侧颈内动脉明显闭塞，管腔因颈动脉夹层而逐渐变细，内有内膜瓣。此外，实验室结果符合抗磷脂综合征（APS）。据作者所知，该患者因前葡萄膜炎返回急诊室，目前正在接受 Cemidon 和阿达木单抗治疗，无症状。我们首次描述了结节病和抗磷脂综合征两种自身免疫性疾病背景下的颈动脉夹层和中心性浆液性脉络膜视网膜病变病例。APS = 抗磷脂综合征，BCVA = 最佳矫正视力，CAD = 颈动脉夹层，CNV = 脉络膜新生血管膜，CSC = 中心性浆液性脉络膜视网膜病变，CT = 计算机断层扫描，ED = 急诊室，ICAD = 颈内动脉夹层，LE = 左眼，OCT = 光学相干断层扫描，RAPD = 相对性传入性瞳孔障碍，RPE = 视网膜色素上皮，RE = 右眼，SRF = 视网膜下积液。
