Ocular findings in a patient with Castleman's disease before and after treatment with immunosuppression and plasmapheresis.
A 12-year-old girl with a 3-month history of epistaxis and Castleman's disease presented with blurred vision in both eyes for 2 weeks. Indirect ophthalmoscopy revealed a blurred optic disc margin, venous engorgement and tortuosity, intraretinal hemorrhages and cotton wool spots, and serous detachment of the neurosensory retina in the posterior pole of each eye. Fluorescein angiography and laboratory tests revealed abnormalities consistent with the clinical examination. Six months following institution of immunosuppressive treatment, cryoglobulin levels decreased and visual acuity and funduscopic abnormalities were markedly improved. However, a few microaneurysms, retinal hemorrhages, and venous engorgement and tortuosity persisted. One month after the cessation of immunosuppressive treatment, symptoms related to the hyperviscosity syndrome recurred and the patient was treated with one session of plasmapheresis. One month after the plasmapheresis, the patient's symptoms resolved, laboratory values were normal, visual acuity was 20/15 in both eyes, and the funduscopic examination of each eye was unremarkable.
Retina and Vitreous Service, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Rodrigo
R
Jorge
Ingrid U
IU
Scott
Rafael C
RC
Oliveira
Rogério A
RA
Costa
Rubens C
RC
Siqueira
Paulo
P
Louzada-Júnior
D000783:Aneurysm / Q000000981:diagnostic imaging; D005871:Castleman Disease / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D004844:Epistaxis / Q000209:etiology; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D007150:Immunohistochemistry; D007165:Immunosuppression Therapy; D008279:Magnetic Resonance Imaging; D009887:Ophthalmoscopy / Q000379:methods; D010956:Plasmapheresis; D011859:Radiography; D012166:Retinal Hemorrhage / Q000209:etiology / Q000473:pathology; D012169:Retinal Vein / Q000000981:diagnostic imaging / Q000473:pathology; D013945:Thymoma / Q000150:complications; D013953:Thymus Neoplasms / Q000150:complications / Q000175:diagnosis; D014786:Vision Disorders / Q000209:etiology* / Q000473:pathology