A Case of Polyarteritis Nodosa with Decreased Vision as a First Symptom.

Kim, Chang Zoo; Nam, Ki Yup; Lee, Sang Joon; Lee, Seung Uk

doi:2015.56.12.1979

J Korean Ophthalmol Soc > Volume 56(12); 2015 > Article

Case Report

Journal of the Korean Ophthalmological Society 2015;56(12):1979-1984.
DOI: https://doi.org/10.3341/jkos.2015.56.12.1979 Published online December 15, 2015.

A Case of Polyarteritis Nodosa with Decreased Vision as a First Symptom.

Chang Zoo Kim, Ki Yup Nam, Sang Joon Lee, Seung Uk Lee

¹Department of Ophthalmology, Kosin University College of Medicine, Busan, Korea. seung28@hanmail.net
²Institute of Medicine, Kosin University College of Medicine, Busan, Korea.

중심망막동맥 폐쇄로 인한 갑작스런 시력저하가 첫 증상으로 나타난 결절다발동맥염 1예

김창주¹⋅남기엽¹⋅이상준^1,2⋅이승욱¹

고신대학교 의과대학 안과학교실¹, 고신대학교 의과대학 의과학연구소²

Received: 19 June 2015 • Revised: 19 August 2015 • Accepted: 16 October 2015

Abstract

PURPOSE
Polyarteritis nodosa (PAN) is the necrotic vasculitis affecting middle and small-sized arteries throughout the body including ocular tissue. We report an atypical PAN case of unilateral central retinal artery occlusion in which the ocular involvement occurred before systemic symptoms. CASE SUMMARY: A 58-year-old male visited the ophthalmology department due to abruptly decreased visual acuity. Best corrected visual acuity (BCVA) was 0.05 (in the right eye) and 1.0 (in the left eye) basedon the Snellen chart. He complained of acute decreased vision occurring ten days prior and intermittent migraine on the right side with no underlying diseases, such as hypertension or diabetes mellitus. Relative afferent pupillary defect was observed in the right eye. Generalized edema was found around the optic disc and fovea on fundus examination and optical coherence tomography. The patient was diagnosed with central retinal artery occlusion (CRAO) based on a fluorescein angiography. Subsequently, PAN was diagnosed based on clinical features, laboratory test results and imaging studies. The treatment was started with an immunosuppressive agent. One month later, the BCVA was 0.05 based on the Snellen chart. CONCLUSIONS: In PAN patients, decreased vision can occur as a first symptom due to CRAO. If the patient visits the ophthalmology clinic, history taking and laboratory tests for PAN can aid in early diagnosis and treatment, as well as preventing additional complications of PAN.

Key Words: Central retinal artery occlusion;Polyarteritis nodosa