Department of Otorhinolaryngology-Head and Neck Surgery, Erlangen University Hospital, University of Erlangen-Nuremberg, Waldstraße 1, 91054, Erlangen, Germany.
Department of Neurology, Erlangen University Hospital, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
J Med Case Rep. 2023 Aug 4;17(1):331. doi: 10.1186/s13256-023-04060-3.
Abrupt visual impairment constitutes a medical urgency, necessitating an interdisciplinary diagnostic and therapeutic approach owing to the broad spectrum of potential etiologies, thereby engaging numerous medical specialties.
A 21-year-old Mixed White and Asian female patient, with medical history of nonsteroidal antiinflammatory drug-exacerbated respiratory disease necessitating previous sinus surgery, reported sudden monocular vision loss. Unremarkable ophthalmological examination of the fellow eye and hematological parameters, save for a slight elevation in lymphocytes and eosinophils, were observed. Imaging studies indicated recurrence of bilateral chronic rhinosinusitis with nasal polyps and a mucocele in the left sphenoid sinus, accompanied by bony structural deficits. Emergency revision sinus surgery, guided by navigation, was promptly performed. The patient received treatment with methylprednisolone, ceftriaxone, cyanocobalamin, pyridoxine, thiamine, and acetylsalicylic acid. During the hospital stay, she developed steroid-induced glaucoma, which was subsequently managed successfully. Negative microbiological swabs, along with pathohistological evidence of increased tissue eosinophilia and the patient's clinical history, led to the diagnosis of toxic retrobulbar neuritis secondary to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-associated chronic rhinosinusitis of the left sphenoid sinus.
In cases of acute unilateral vision loss, optic neuritis is a highly probable differential diagnosis and may be induced by pathologies of the paranasal sinuses. Nonsteroidal antiinflammatory drug-exacerbated respiratory disease, a subtype of chronic rhinosinusitis, is associated with type 2 inflammation, which is increasingly recognized for its role in the pathogenesis of bronchial asthma, eosinophilic esophagitis, and atopic eczema. Clinicians should consider chronic rhinosinusitis as a potential differential diagnosis in unilateral visual loss and be cognizant of the rising significance of type 2 inflammations, which are relevant to a variety of diseases.
突发性视力障碍构成了一种医学急症，由于潜在病因广泛，需要采用跨学科的诊断和治疗方法，因此涉及众多医学专业。
一名 21 岁的混血白人和亚洲女性患者，因非甾体抗炎药加重的呼吸道疾病需要进行先前的鼻窦手术，报告突然出现单眼视力丧失。对另一只眼睛进行了无明显异常的眼科检查和血液学参数检查，除淋巴细胞和嗜酸性粒细胞略有升高外，未见异常。影像学研究表明双侧慢性鼻-鼻窦炎伴鼻息肉和左侧蝶窦黏液囊肿复发，伴有骨结构缺损。迅速通过导航引导进行了急诊鼻窦翻修手术。患者接受了甲基强的松龙、头孢曲松、氰钴胺、吡哆醇、硫胺素和乙酰水杨酸治疗。在住院期间，她发生了类固醇诱导性青光眼，随后成功进行了治疗。阴性微生物拭子检查，加上组织嗜酸性粒细胞增多的病理组织学证据和患者的临床病史，导致诊断为左侧蝶窦复发性非甾体抗炎药加重的呼吸道疾病相关慢性鼻-鼻窦炎继发的中毒性球后视神经炎。
在急性单侧视力丧失的情况下，视神经炎是一种高度可能的鉴别诊断，可能由副鼻窦疾病引起。非甾体抗炎药加重的呼吸道疾病是慢性鼻-鼻窦炎的一个亚型，与 2 型炎症相关，2 型炎症在支气管哮喘、嗜酸性食管炎和特应性皮炎的发病机制中越来越受到重视。临床医生应将慢性鼻-鼻窦炎视为单侧视力丧失的潜在鉴别诊断，并认识到 2 型炎症的重要性日益增加，与多种疾病相关。
