title: Central retinal artery occlusion in Wegener's granulomatosis: a diagnostic dilemma.
abstract: OBJECTIVE
  To report a case of central retinal artery occlusion (CRAO) in a patient with biopsy-verified Wegener's granulomatosis (WG) with positive C-ANCA.
  
  
  METHODS
  A 55-year-old woman presented with a 3-day history of acute painless bilateral loss of vision; she also complained of fever and weight loss. Examination showed a CRAO in the left eye and angiographically documented choroidal ischemia in both eyes.
  
  
  RESULTS
  The possibility of systemic vasculitis was not kept in mind until further studies were carried out; methylprednisolone pulse therapy was then started. Renal biopsy disclosed focal and segmental necrotizing vasculitis of the medium-sized arteries, supporting the diagnosis of WG, and cyclophosphamide pulse therapy was administered with gradual improvement, but there was no visual recovery.
  
  
  CONCLUSIONS
  CRAO as presenting manifestation of WG, in the context of retinal vasculitis, is very uncommon, but we should be aware of WG in the etiology of CRAO. This report shows the difficulty of diagnosing Wegener's granulomatosis; it requires a high index of suspicion, and we should obtain an accurate medical history and repeat serological and histopathological examinations. It emphasizes that inflammation of arteries leads to irreversible retinal infarction, and visual loss may occur.
authors.affiliation: Department of Ophthalmology, Hospital Universitario de Canarias, Ctra. Gral del sur s/n, 38300, La Laguna, Tenerife, Spain, vlozano77@hotmail.com.
authors.forename: Virginia
authors.initials: V
authors.lastname: Lozano-López
authors.forename: Beatriz
authors.initials: B
authors.lastname: Rodríguez-Lozano
authors.forename: María José
authors.initials: MJ
authors.lastname: Losada-Castillo
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Delgado-Frías
authors.forename: David
authors.initials: D
authors.lastname: Dopazo-Luque
authors.forename: Miguel
authors.initials: M
authors.lastname: Serrano-García