Bilateral optic neuritis in wegener granulomatosis.
A 32-year-old patient with recurrent sinusitis had severe visual loss from optic neuropathy. Imaging revealed severe bone destruction and soft tissue densities of the paranasal sinuses and enhancement of the dura of the frontal sinuses, optic canals, and superior orbital fissures bilaterally. Endoscopic sinusectomy with biopsy showed granulomatous vasculitis compatible with Wegener granulomatosis (WG). The patient was treated with intravenous and oral corticosteroids and oral cyclophosphamide that led to rapid and dramatic visual recovery. This case draws attention to the fact that optic neuritis may be an early inflammatory manifestation of WG and that rapid diagnosis and aggressive anti-inflammatory treatment is critical before inflammation of arteries leads to infarction and irreversible visual loss.
Monteiro
Mário Luiz Ribeiro
ML
Department of Ophthalmology, Hospital das Clínicas of the University of São Paulo Medical School, São Paulo, Brazil. mlrmonteiro@terra.com.br
Borges
Wander Inturias Sergillo
WI
do Val Ferreira Ramos
Carolina
C
Lucato
Leandro Tavares
LT
Leite
Cláudia Costa
CC
D000328:Adult; D003520:Cyclophosphamide / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use; D014890:Granulomatosis with Polyangiitis / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009902:Optic Neuritis / Q000150:complications / Q000209:etiology*; D011241:Prednisone / Q000627:therapeutic use; D012008:Recurrence; D012852:Sinusitis / Q000175:diagnosis / Q000209:etiology*; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology* / Q000503:physiopathology; D014792:Visual Acuity; D014794:Visual Fields
D005938:Glucocorticoids; D003520:Cyclophosphamide; D011241:Prednisone