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Unilateral occlusive vasculitis: differential approach in a patient with poor cooperation

Poster Details

First Author: M.Phylactou CYPRUS

Co Author(s):    S. Pipis   K. Tyrlis                 

Abstract Details

Purpose:

To report an interesting case of unilateral occlusive vasculitis.

Setting:

Department of Ophthalmology, Makarios Hospital, Nicosia, Cyprus

Methods:

A Caucasian 45-year old male with psychiatric disorder under treatment came complaining about acute visual loss of RE. Best corrected visual acuity on the RE was counting fingers and on the LE was 10/10. Applanation pressures were 14mmHg RE and 15mmHg LE. Anterior segment examination of both eyes was normal. Fundoscopy of RE revealed mild vitritis, papilledema, macular oedema, perivascular sheathing and diffuse retinal haemorraghes superior-temporal. The patient did not mention any other symptoms and denied further physical examination. His medical record revealed incident of haematochesia 2 years ago and colonoscopy findings were gastrointestinal ulcerations of the rectum.

Results:

First results indicated three-digit number of CMV IgG and normal IgM. Therefore vitreous biopsy PCR was performed to exclude viral vasculitis.Vitreous PCR for viruses and VDRL test were negative and the other blood and imaging tests were normal. Fluorescein angiography displayed hypofluorescence superior-temporal, leakage of dye in macula and optic disc on the RE and on the LE there were no signs of subclinical vasculitis even in late phases. The next day of admission the patient mentioned pain in the oral cavity hence he accepted further physical examination, which showed aphthous ulcerations of the oral cavity and skin lesions on legs and back. Pathergy test was negative and few days’ later HLA-B27 test result was positive. Rheumatologist consultation was asked.

Conclusions:

Diagnosis of Behcet’s disease is based on the clinical manifestations and there is not any specific test for confirmation. In our case, the unilateral vasculitis together with poor patient’s cooperation and elevated CMV IgG number forced us to exclude viral vasculitis before starting treatment with high doses of IV methylprednisolone.

Financial Disclosure:

NONE

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