Peripheral Retinal Neovascularization in a Patient with Sarcoidosis and Cocaine-Associated Autoimmunity.

Ramak Roohipourmoallai,Seyed Majid Hosseinian Benvidi,Samaneh Davoudi,Siva S R Iyer

doi:10.1155/2021/9923260

Ramak Roohipourmoallai, Seyed Majid Hosseinian Benvidi + Show 2 more

Open Access

https://doi.org/10.1155/2021/9923260

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Abstract

A 63-year-old African-American female with history of sarcoidosis (lymph node biopsy proven) and cocaine abuse for 8 years was referred to us because of new floater. Her ocular history was unremarkable except for vague complaints of visual disturbance during a hospital admission in 2016. On presentation, her visual acuity was 20/400 in the right eye and 20/30 in the left eye. Dilated fundus exam and multimodal imaging showed thick epiretinal membrane (ERM) superior to optic nerve head causing a lamellar macular hole and intra retinal edema in the right eye, a full thickness macular hole, and peripheral neovascularization in the left eye. Peripheral vasculitis was appreciated in both eyes and peripheral neovascularization in the left eye on fluorescein angiography. The patient underwent laser therapy, and the new vessels regressed in the left eye without any changes in systemic medications. Multiple factors may contribute to retinal vasculitis and neovascularization including sarcoidosis, cocaine abuse, and other undiagnosed systemic vasculitis, which makes this case a mystery.

Highlights

There are many reported etiologies for retinal vasculitis as described by Rosenbaum et al [1], including systemic disease or as a part of an infectious process
We report a case of proven history of sarcoidosis, cocaine abuse, and some nonspecific immunologic serologic findings in a patient with maculopathy, retinal vasculitis, and retinal neovascularization
The patient had been on oral prednisone 50 mg daily, but she stopped taking it years prior to presentation because of adverse side effects of nightmares and hirsutism. Her ocular history was unremarkable except vague complaints of a visual disturbance during one of her hospital admissions in 2016

Summary

Introduction

There are many reported etiologies for retinal vasculitis as described by Rosenbaum et al [1], including systemic disease or as a part of an infectious process. A 63-year-old African-American female with a past medical history of lymph node biopsy proven sarcoidosis in her early 40s was referred to us for new left eye floater assessment Her medical history included sarcoidosis (diagnosed in 2008), COPD, pulmonary hypertension, smoking, and crack/cocaine abuse for eight years. She had a history of many neurologic episodes (TIA) with no obvious evidence of acute intracranial abnormality, brain perfusion abnormalities, or flow-limiting stenosis on workup. The patient had been on oral prednisone 50 mg daily, but she stopped taking it years prior to presentation because of adverse side effects of nightmares and hirsutism Her ocular history was unremarkable except vague complaints of a visual disturbance during one of her hospital admissions in 2016. Though the patient’s peripheral retinal neovascularization was controlled with laser only, the patient was started on azathioprine by her treating team for her systemic issues

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