Adult ; Humans ; Methylprednisolone ; therapeutic use ; Optic Neuritis ; diagnosis ; drug therapy ; etiology ; Spondylitis, Ankylosing ; complications

A 21-year-old woman presented with bilateral optic neuritis, combined with central retinal vein occlusion. General physical examination and neurologic consultation revealed no other findings. Laboratory investigation yielded an elevated erythrocyte sedimentation rate, positive LE preparation, elevated ANA titer, and elevated blood urea nitrogen and creatinine levels. Diagnosis of systemic lupus erythematosus (SLE) was made. Renal failure developed quickly and she was treated with hemodialysis, transfusion and subsequently systemic corticosteroid. Anti-phospholipid antibody was positive to lupus anti-coagulant and the titer was normalized after 2-month steroid therapy at which time the visual outcome differed between the eyes. The right eye showed improvement in visual acuity and visual field, but the left eye was not improved and retained a central scotoma. SLE needs to be considered in young women with optic neuritis when other causes of optic neuritis have been excluded, and serologic tests including anti-phospholipid antibody should be conducted.
Adult ; Case Report ; Female ; Fluorescein Angiography ; Human ; Lupus Erythematosus, Systemic/complications/*diagnosis/drug therapy ; Optic Neuritis/*diagnosis/drug therapy/etiology ; Perimetry ; Prednisolone/*therapeutic use ; Treatment Outcome ; Visual Acuity ; Visual Fields

A 59-year-old woman was referred to our clinic with sudden visual loss in her right eye after she was treated with 40 mg/day of oral prednisolone for 2 weeks under the diagnosis of idiopathic optic neuritis. At that time, computerized tomography (CT) of the brain showed no evidence of optic nerve or brain pathology. However, there was progressive diminution of right visual acuity associated with a limitation of adduction and abduction in the right eye. On magnetic resonance imaging and repeated CT, a malignant lesion was suggested, and was confirmed as an Aspergillus fungus colony by histopathologic examination. Postoperatively, she was treated with intravenous administration of amphotericin B for 13 weeks. However, her condition continued to deteriorate. She developed ptosis and total ophthalmoplegia in the right eye and blindness in both eyes. After discharge, she was given itraconazole for 20 weeks. She has shown no recovery of visual acuity or extraocular motion during a two-year follow-up period. The clinical features of our case suggest that early diagnosis in a case of aspergilloma presenting with visual loss is difficult and that a high index of suspicion, repeated radiological examination and adequate biopsy may be required for diagnosis.
Amphotericin B/therapeutic use ; Antifungal Agents/therapeutic use ; Aspergillosis/diagnosis/drug therapy/*microbiology ; Blindness/etiology ; Diagnosis, Differential ; Eye Infections, Fungal/diagnosis/drug therapy/*microbiology ; Female ; Human ; Itraconazole/therapeutic use ; Magnetic Resonance Imaging ; Middle Aged ; Optic Neuritis/diagnosis/drug therapy/*microbiology ; Visual Acuity