钙化防御，谨防眼部类似病症：病例系列
Calciphylaxis, beware the ophthalmic mimic: A case series.
作者信息
Guymer Chelsea, Jahan Sadia, Bahrami Bobak, Sia David, Tan Bee Qung, McDonald Stephen, Simon Sumu
机构信息
Department of Ophthalmology, and.
Central and Northern Adelaide Renal and Transplantation Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
出版信息
Clin Nephrol Case Stud. 2023 Dec 12;11:136-146. doi: 10.5414/CNCS111088. eCollection 2023.
PURPOSE
We present two atypical cases of calciphylaxis presenting with ocular ischemic pathology - both without the hallmark cutaneous manifestations - to raise awareness of this rare yet highly disabling condition.
OBSERVATIONS
We report two cases of ophthalmic calciphylaxis presenting as (1) anterior ischemic optic neuropathy (AION) and cilioretinal artery occlusion in a 76-year-old woman with pre-dialysis kidney failure, and (2) AION with contralateral central retinal artery occlusion (CRAO) in a 44-year-old man on hemodialysis.
CONCLUSION AND IMPORTANCE
These cases highlight the need for judicious clinical suspicion of calciphylaxis in patients with kidney failure, presenting with microvascular ischemic ophthalmic pathology such as AION or CRAO. Confirmation with temporal artery biopsy is essential to direct targeted individualized multi-disciplinary treatment of calciphylaxis and avoid unnecessary steroid exposure in cases masquerading as giant cell arteritis (GCA).
目的
我们报告两例不典型的钙化防御病例，其表现为眼部缺血性病变，均无典型的皮肤表现，以提高对这种罕见但致残性高的疾病的认识。
观察结果
我们报告了两例眼部钙化防御病例，分别为：（1）一名患有透析前肾衰竭的76岁女性，表现为前部缺血性视神经病变（AION）和睫状视网膜动脉阻塞；（2）一名接受血液透析的44岁男性，表现为AION伴对侧视网膜中央动脉阻塞（CRAO）。
结论与意义
这些病例强调，对于出现微血管缺血性眼部病变（如AION或CRAO）的肾衰竭患者，需要审慎怀疑钙化防御。通过颞动脉活检进行确诊对于指导钙化防御的针对性个体化多学科治疗至关重要，并且可避免在伪装为巨细胞动脉炎（GCA）的病例中不必要的类固醇暴露。
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