Panse Ketaki, Herrera Manuela, Fung Maxwell, Brassard Alain, Moussa Kareem
Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA.
University of California, Davis, School of Medicine, Sacramento, CA, USA.
Am J Ophthalmol Case Rep. 2023 Jul 26;32:101908. doi: 10.1016/j.ajoc.2023.101908. eCollection 2023 Dec.
To report the clinical and histopathologic features of necrobiosis lipoidica and associated retinal vasculitis and describe successful treatment of both skin and eye manifestations with adalimumab, a tumor necrosis factor (TNF)-alpha inhibitor.
A 35-year-old patient with bipolar disorder and ocular hypertension was referred for evaluation of bilateral retinal vasculitis. Fluorescein angiography revealed bilateral occlusive retinal vasculitis. Physical exam was notable for multiple annular and round erythematous hyperpigmented and atrophic patches and plaques on both lower extremities. Skin biopsy revealed a diagnosis of necrobiosis lipoidica, a rare granulomatous skin disease. Both the patient's retinal vasculitis and skin patches responded favorably to treatment with adalimumab, a TNF-alpha inhibitor.
This case highlights the importance of obtaining a complete history and physical exam in patients who present with ocular inflammation, as extraocular manifestations of disease may be present. It also demonstrates the effectiveness of a multidisciplinary approach to evaluation and management of these patients, as both skin and eye involvement were successfully treated with adalimumab, a TNF-alpha inhibitor.
报告类脂质渐进性坏死及相关视网膜血管炎的临床和组织病理学特征，并描述使用肿瘤坏死因子（TNF）-α抑制剂阿达木单抗成功治疗皮肤和眼部表现的情况。
一名患有双相情感障碍和高眼压的35岁患者因双侧视网膜血管炎接受评估。荧光素血管造影显示双侧闭塞性视网膜血管炎。体格检查发现双下肢有多个环形和圆形红斑色素沉着和萎缩性斑片及斑块。皮肤活检诊断为类脂质渐进性坏死，一种罕见的肉芽肿性皮肤病。患者的视网膜血管炎和皮肤斑片对TNF-α抑制剂阿达木单抗治疗反应良好。
该病例强调了对出现眼部炎症的患者进行完整病史和体格检查的重要性，因为可能存在疾病的眼外表现。它还证明了多学科方法对这些患者进行评估和管理的有效性，因为皮肤和眼部受累均通过TNF-α抑制剂阿达木单抗成功治疗。
