Sitaula Ranju Kharel, Shah Chiranjiwi Prasad, Shrestha Saurav Man
Department of Ophthalmology, B.P Koirala Lions Centre for Ophthalmic Studies.
Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj.
Ann Med Surg (Lond). 2023 May 26;85(7):3692-3696. doi: 10.1097/MS9.0000000000000905. eCollection 2023 Jul.
Frosted branched angiitis (FBA) is characteristic florid translucent retinal perivascular sheathing of both arterioles and venules in association with variable uveitis and vasculitis affecting the entire retina. The vascular sheathing is supposed to be an immune-mediated reaction, possibly due to immune complex deposition in vessel walls secondary to various underlying etiologies. The authors aim to report a case of FBA secondary to herpes simplex virus and infection causing the diagnostic dilemma. This is the first case report on FBA from Nepal.
An 18-year-old young boy hospitalized with the diagnosis of acute viral meningo-encephalitis presented with the complaint of diminution of vision and floaters in both eyes for a week. Herpetic infection was confirmed with the cerebro-spinal fluid analysis and was under antiviral drugs. His presenting visual acuity was 20/80 in both eyes and ocular features were suggestive of FBA. The vitreous sample analysis revealed raised toxoplasma titre so intravitreal clindamycin was administered twice. The ocular features resolved in the subsequent follow ups with intravenous antiviral treatment and intravitreal antitoxoplasma treatment.
FBA is a very rare clinical syndrome secondary to many immunological or pathological causes. So, possible etiologies must be ruled out for timely management and good visual prognosis.
霜样分支状血管炎（FBA）的特征是小动脉和小静脉出现明显的半透明视网膜血管周围鞘，伴有不同程度的葡萄膜炎和影响整个视网膜的血管炎。血管鞘被认为是一种免疫介导的反应，可能是由于各种潜在病因继发免疫复合物在血管壁沉积所致。作者旨在报告一例继发于单纯疱疹病毒感染并导致诊断困境的FBA病例。这是尼泊尔关于FBA的首例病例报告。
一名18岁的年轻男孩因急性病毒性脑膜脑炎入院，主诉双眼视力下降和眼前有漂浮物一周。脑脊液分析确诊为疱疹感染，正在接受抗病毒药物治疗。他就诊时双眼视力均为20/80，眼部特征提示为FBA。玻璃体样本分析显示弓形虫滴度升高，因此两次给予玻璃体内克林霉素治疗。经静脉抗病毒治疗和玻璃体内抗弓形虫治疗后，在随后的随访中眼部特征得到缓解。
FBA是一种继发于多种免疫或病理原因的非常罕见的临床综合征。因此，必须排除可能的病因，以便及时治疗并获得良好的视力预后。
