Bilateral Neuroretinitis Research Articles

Diagnostic and Therapeutic Challenges.

Diagnostic and Therapeutic Challenges.

Choroidal neovascularization secondary to ocular syphilis

Choroidal neovascularization (CNV) is a very rare but sight-threatening complication of ocular syphilis. We reported the case of a 51-year-old woman who presented with a 2-week history of visual loss in the right eye (RE). Fundus examination demonstrated vitritis and the optic disc margin blurring. Fundus fluorescein angiography (FFA) showed the presence of optic nerve edema, macular edema, and diffused impairment of the blood-retinal barrier with leakage areas, which led to the diagnosis of bilateral neuroretinitis. Optical coherence tomography (OCT) of the right macula evidenced irregularities of the retinal pigment epithelium (RPE), subretinal fluid and hyperreflective material. Besides, workup indicated positive serology for syphilis and the patient received combined treatment of ceftriaxone, systemic and topical steroids as well as cycloplegic medications. The woman did not consent to lumbar puncture or intravitreal anti-vascular epithelial growth factor (anti-VEGF) injection, therefore the prognosis for improvement of visual acuity is poor.Abbreviations: anti-VEGF = anti-vascular epithelial growth factor, AMD = age related macular degeneration, BCVA = best corrected visual acuity, CNS = central nervous system, CNV = choroidal neovascularization, CSF = cerebrospinal fluid, FFA = fundus fluorescein angiography, FTA-ABS = fluorescent treponemal antibody absorption, HIV = human immunodeficiency virus, iCNV = inflammatory CNV, IOP = intraocular pressure, LE = left eye, MRI = magnetic resonance imaging, OCT = optical coherence tomography, OCTA = optical coherence tomography angiography, RE = right eye, RPE = retinal pigment epithelium, RPR = rapid plasma regain, TP-PA = Treponema pallidum particle agglutination, VDRL = Venereal Disease Research Laboratory

Disseminated tuberculosis presenting as bilateral neuro-retinitis.

Disseminated tuberculosis presenting with intraocular involvement is a rare condition which can lead to profound visual loss if misdiagnosed. We report a case of a 24-year-old Nepalese male with disseminated tuberculosis who presented primarily with bilateral vision loss.

Tuberculosis related Neuroretinitis and Retinal Vasculitis in an Immunocompetent Patient

Introduction: This study aimed to describe the occurrence of bilateral neuroretinitis and retinal vasculitis in an immunocompetent female with disseminated tuberculosis. Case description: A 25 year old female diagnosed with disseminated tuberculosis presented with sudden painful loss of vision bilaterally. On examination she was found to have bilateral neuroretinitis and retinal periphlebitis involving the posterior pole. She was prescribed systemic steroids in addition to the anti-tuberculous therapy that she was receiving. The fundus lesions gradually resolved over four months with modest improvement in visual acuity. There were no recurrences in the follow up period of 14 months. Conclusions: Ocular involvement in the form of neuroretinitis with concomitant retinal vasculitis can occur in patients with disseminated tuberculosis. Addition of systemic steroids to anti-tuberculous therapy leads to anatomical resolution with improvement in visual acuity.

Bilateral neuroretinitis and anterior uveitis following ipilimumab treatment for metastatic melanoma.

BackgroundThis report presents a novel case of bilateral neuroretinitis and anterior uveitis in a patient receiving ipilimumab treatment for metastatic cutaneous melanoma and summarizes the literature regarding treatment options for patients with ipilimumab-related ocular immune-related adverse events.FindingsThe medical chart was reviewed, a literature search was performed, and the results were summarized. For the case presented here, in addition to discontinuation of ipilimumab, combined topical and oral corticosteroid therapy provided visual recovery and resolution of ocular inflammation over 2 months. Review of the literature identified that the majority of reported patients required treatment with oral corticosteroids for control of ocular and periocular inflammation.ConclusionsIpilimumab-induced ocular inflammation is a rare adverse immune event. This case, in conjunction with the current literature, suggests that in the setting of severe ocular inflammation, treatment with both topical and oral corticosteroids are typically required for management and preservation of good visual function.

Bilateral ocular involvement in a patient with tertiary syphilis

AbstractPurpose To report a case of a 46‐year‐old man with bilateral neuroretinitis due to tertiary syphilis.Methods The patient presented at the clinic with a history of blurred vision. He was agitated and was looking unwell. Snellen Visual acuity (VA) was 0.2 in the right eye and 0.1 in the left eye. Pupillary reflexes to light were sluggish but normally reactive to accommodation. Fundoscopy showed bilateral optic disc oedema and fluorescein angiography revealed active neuroretinitis. Visual fields (VF) were abnormal in both eyes. Laboratory blood tests, cardiological investigations and a brain MRI were performed. Mantoux test was negative and IV treatment with corticosteroids was initiated.Results Treatment with steroids was discontinued due to the appearance of a maculopapular rash on the head and neck. Laboratory results showed: RPR (Rapid Plasma Reagin)/FTA: positive, TPPA of serum and CSF (IgG, IgM): positive. Virological tests were negative. Based on these findings the diagnosis of neurosyphilis was made. Cardiological investigation was normal and brain MRI did not show any major abnormalities. Patient was started on IV crystalline penicillin, 3‐4 million units q 4h for two weeks. Three months after treatment VA was 0.6 in the right eye and 0.4 in the left. There was an improvement on the VF mainly in the right eye. Electro‐encephalogram showed no significant pathology. ISCEV standard full field and pattern electroretinography were affected bilaterally.Conclusion Bilateral neuroretinitis due to tertiary syphilis affects vision and complete visual recovery may not occur despite adequate treatment.

A case of paraneoplastic optic neuropathy and outer retinitis positive for autoantibodies against collapsin response mediator protein-5, recoverin, and α-enolase

BackgroundSpecific cross-reacting autoimmunity against recoverin or collapsin response mediator protein (CRMP)-5 is known to cause cancer-associated retinopathy or paraneoplastic optic neuropathy, respectively. We report a rare case with small cell lung carcinoma developing bilateral neuroretinitis and unilateral focal outer retinitis positive for these antibodies.Case presentationA 67-year-old man developed bilateral neuroretinitis and foveal exudation in the right eye. Optical coherence tomography showed a dome-shaped hyperreflective lesion extending from inner nuclear layer to the photoreceptor layer at the fovea in the right eye. Single-flash electroretinography showed normal a-waves in both eyes and slightly reduced b-wave in the left eye. Results of serological screening tests for infection were within normal limits. The patient’s optic disc swelling and macular exudation rapidly improved after oral administration of prednisolone. Systemic screening detected lung small cell carcinoma and systemic chemotherapy was initiated. Immunoblot analyses using the patient’s serum detected autoantibodies against recoverin, CRMP-5, and α-enolase, but not carbonic anhydrase II. Neuroretinitis once resolved after almost remission of carcinoma on imaging but it recurred following the recurrence of carcinoma.ConclusionsThe development of neuroretinitis in this cancer patient with anti-retinal and anti-optic nerve antibodies depended largely on the cancer activity, suggesting the possible involvement of paraneoplastic mechanisms. Patients with paraneoplastic optic neuropathy and retinopathy are likely to develop autoimmune responses against several antigens, thus leading to various ophthalmic involvements.

Neurorétinite stellaire bilatérale révélant un phéochromocytome

We report the case of a 21-year-old male patient admitted emergently with progressive bilateral severe visual loss for 1 month. Posterior segment examination revealed bilateral stellate neuroretinitis. Infectious serologies were negative, and brain CT was normal. Physical examination was remarkable for malignant hypertension of 220/150 mmHg. Diagnostic work-up revealed a pheochromocytoma documented by histopathological exam upon adrenalectomy. The disc edema and macular exudates resolved once the hypertension was controlled.

Paradoxical response in ocular bartonellosis

IntroductionCat scratch disease is an infectious disease caused by thebacteria Bartonella henselae [1] and is transmitted by catscratches or exposure to cat saliva. The spectrum of itsocular manifestations includes Parinaud's oculoglandularsyndrome, iritis, vitritis, neuroretinitis, panuveitis, retinitisappearing as small white intraretinal infiltrates, and choroi-dal white lesions [1, 2]. B. henselae is reported to be themost common cause of neuroretinitis; typically character-ized by optic disk edema in association with a partial orcomplete macular star. The majority of infected patientspresenting with neuroretinitis reported in the literature aretreated with antibiotics. In some cases steroids were added.However several reports showed that even patients who didnot receive treatment had an excellent visual outcome [1].We describe here a paradoxical response to treatment in ayoung female presenting with bilateral neuroretinitis andinflammatory optic disk lesions.Case reportA 19-year-old healthy female presented with an abruptdeterioration of left eye vision of 1-day duration. For10 days prior to presentation, she was suffering from drycough; 5 days later she had intermittent fever up to 41°Cwith shaking chills. There was a history of contact with acat, but she denied being scratched. On admission, physicaland neurologic examinations were unremarkable. Ophthal-mologic assessment disclosed visual acuity of 4/4 in theright eye and 4/60 in the left eye. She had normal anteriorsegments and intraocular pressures. A left afferent pupillarydefect was noted. Funduscopy of the right eye showed asmall white optic disk lesion in its temporal aspect with adeep retinal white lesion along the superonasal arcade(Fig. 1). The left optic disk had blurred margins with biggerwhite lesions in its nasal and temporal aspects with anassociated localized vitreous opacity on its surface (Fig. 1).There was marked macular edema and two deep retinalwhite lesions along the superotemporal arcade and infer-onasal to the optic disk. Optical coherence tomography(OCT) revealed intraretinal fluid in the right papillomacularbundle and left exudative macular detachment (Fig. 2).Visual field examination showed right nasal step andsuperonasal arcuate defect while there was enlargement ofthe left blind spot with nasal step (Fig. 3). Work-uprevealed mild anemia with hemoglobin of 11.7 g% andleukocytosis of 14,800 (lymphocytes, 31%). Kidney andliver functions were within normal limits except for aslightly elevated lactate dehydrogenase at 768 (normalrange, 300–620 u/l). She had elevated erythrocyte sedi-mentation rate (ESR) (90 mm/h) and C-reactive protein(5.3 mg%; normal range, less than 1). Chest X-ray did notreveal any pathological findings, and CT scan and MRI ofthe head and brain showed mild thickening of the opticnerves bilaterally and hyperintense foci in the flairsequences in the intraocular aspects of the optic nerves,respectively. Cerebrospinal fluid cytology was normal.Serological tests were negative for HIV, syphilis, Brucella,Coxiella burnetti, toxoplasma, and toxocara. Serologicaltests for B. henselae revealed positive IgM titer at 75 units

A case of bilateral presumed chikungunya neuroretinitis

Chikungunya fever is a relatively rare from of vector-borne viral fever caused by chikungunya virus and spread by bites of the Aedes aegypti and Aedes albopictus mosquito. Epidemics of chikungunya fever have been reported in the past from different parts of the world. Although the virus had been passive for quite some time, recent reports of outbreaks of chikungunya fever in several parts of Southern India have confirmed the re-emergence of this virus. Symptoms of this infection include abrupt onset of fever, chills, and headache, rash, severe joint pain, conjunctival injection and photophobia. Ocular manifestations have been recently reported with this infection. We report a case of a 48-year-old female patient, who presented with defective vision two weeks after a serology proven chikungunya infection. There was bilateral neuroretinitis with peripapillary cotton wool spots. These findings should be kept in mind as an ocular manifestation of chikungunya virus infection.

Bilateral Neuroretinitis With Peripapillary Serous Retinal Detachments in a Patient With HIV and HBV

Bilateral Neuroretinitis With Peripapillary Serous Retinal Detachments in a Patient With HIV and HBV

Bilateral neuro-retinitis following chick embryo cell anti-rabies vaccination – a case report

BackgroundThe Optic nerve is rarely involved after sheep brain anti-rabies vaccination in the form of retrobulbar neuritis or papillitis. Bilateral neuroretinitis after chick embryo cell antirabies vaccination has not been reported.Case presentationWe report the case of a 56 year old male who developed bilateral neuro-retinitis following three injections of antirabies vaccine prepared from the chick embryo.ConclusionThe chick embryo cell antirabies vaccine can cause bilateral neuroretinits which has not been reported previously.

Spirochetes in the aqueous humor in seronegative ocular syphilis. Persistence after penicillin therapy.

A young woman with a gradual onset of blurred vision was found to have a bitemporal hemianopia. It was possible that these symptoms represented an early optochiasmatic arachnoiditis. Inflammatory eye changes with bilateral neuroretinitis and anterior uveitis were then noted. A protracted course of exacerbations and remissions occurred during a one-year course of systemic steroid therapy. After a reactive fluorescent treponemal antibody absorption test was found, spirochetes were demonstrated in the aqueous humor. The patient was then given more than nine million units of long-acting penicillin. One month later, at a second paracentesis, spirochetes were again found. These organisms were motile on darkfield examination, and stained with fluorescein tagged anti-Treponema pallidumglobulin.