巩膜炎作为肉芽肿性多血管炎的先兆。
Scleritis as the harbinger of Granulomatosis with polyangiitis.
作者信息
Kharel Sitaula Ranju, Maskey Himang Man Singh, Chaudhary Santosh, Jha Saket
机构信息
Department of Ophthalmology, B. P. Koirala Lions Centre for Ophthalmic Studies, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
Department of Ophthalmology, B. P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal.
出版信息
Ann Med Surg (Lond). 2022 Nov 18;84:104908. doi: 10.1016/j.amsu.2022.104908. eCollection 2022 Dec.
INTRODUCTION
Ocular and orbital involvement in Granulomatosis with polyangiitis (GPA) is common. GPA can lead to life and sight threatening complications due to necrosis and tissue melting.
CASES
We report four cases presenting with ocular pain and redness for varied durations. One had diminution of vision. All of them had deep sectoral/diffuse congestion with one having scleral thinning. All were diagnosed with anterior necrotizing/non-necrotizing scleritis. One had associated penetrating ulcerative keratitis. Topical steroids and systemic non-steroidal anti-inflammatory drugs were started in all cases and rheumatology consultation was taken. Pertinent investigations were sent, and GPA was diagnosed. Intravenous immunosuppressive regimens and oral steroid were started and significant improvements were seen, preventing untoward complications.
CONCLUSION
Scleritis could be manifesting feature of GPA so cautious history taking and evaluation is important. Management often requires multidisciplinary care and ocular features could be the reference guidelines to adjust dose of systemic medications of GPA.
引言
肉芽肿性多血管炎（GPA）累及眼部和眼眶很常见。由于坏死和组织溶解，GPA可导致危及生命和视力的并发症。
病例
我们报告了4例出现不同时长眼痛和眼红的病例。其中1例视力下降。所有患者均有深部扇形/弥漫性充血，1例有巩膜变薄。所有患者均被诊断为前部坏死性/非坏死性巩膜炎。1例伴有穿透性溃疡性角膜炎。所有病例均开始使用局部类固醇和全身性非甾体抗炎药，并咨询了风湿病科。进行了相关检查，确诊为GPA。开始静脉注射免疫抑制方案和口服类固醇，病情有显著改善，避免了不良并发症。
结论
巩膜炎可能是GPA的表现特征，因此谨慎的病史采集和评估很重要。治疗通常需要多学科护理，眼部特征可作为调整GPA全身用药剂量的参考指南。
Zotero 插件