Moses Mary M, Fischer Nathan A, Elston Carly, Dib Bernard
Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Retina Consultants of Alabama, Birmingham, AL, USA.
J Vitreoretin Dis. 2024 Jun 10;8(4):471-475. doi: 10.1177/24741264241252588. eCollection 2024 Jul-Aug.
To present a case of central retinal artery occlusion (CRAO) leading to the diagnosis of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) within 1 week of an adenovirus vector COVID-19 vaccination. A case was reviewed. A 50-year-old man with atopic dermatitis and asthma presented with acute painless vision loss in 1 eye. An examination and imaging findings showed CRAO. Further evaluation found eosinophilia and elevated inflammatory markers. A workup for vasculitis showed elevated cytoplasmic-antineutrophil cytoplasmic antibody, perinuclear-antineutrophil cytoplasmic antibody, myeloperoxidase antibody, rheumatoid factor, and total immunoglobulin E. Skin biopsies were consistent with eosinophilic granulomatosis with polyangiitis. Steroids, cyclophosphamide, and mepolizumab were initiated. At 1 year, the patient's systemic symptoms had improved but his vision had not. Few reports exist of CRAO associated with eosinophilic granulomatosis with polyangiitis, with no other instances related to an adenovirus vector COVID-19 vaccination. Treating a systemic vasculitis early can be vision saving in the fellow eye and prevent systemic life-threatening complications.
报告1例在接种腺病毒载体COVID-19疫苗1周内发生视网膜中央动脉阻塞（CRAO）并导致诊断为嗜酸性肉芽肿性多血管炎（Churg-Strauss综合征）的病例。回顾1例病例。一名患有特应性皮炎和哮喘的50岁男性出现单眼急性无痛性视力丧失。检查和影像学检查结果显示为CRAO。进一步评估发现嗜酸性粒细胞增多和炎症标志物升高。血管炎检查显示胞质抗中性粒细胞胞质抗体、核周抗中性粒细胞胞质抗体、髓过氧化物酶抗体、类风湿因子和总免疫球蛋白E升高。皮肤活检结果符合嗜酸性肉芽肿性多血管炎。开始使用类固醇、环磷酰胺和美泊利单抗治疗。1年后，患者的全身症状有所改善，但视力未改善。与嗜酸性肉芽肿性多血管炎相关的CRAO报道很少，且没有其他与腺病毒载体COVID-19疫苗相关的病例。早期治疗全身性血管炎可挽救患眼视力并预防危及生命的全身性并发症。
