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Kowallick A, Koziolek M, Neß T, Feltgen N, Hoerauf H, Bemme S. [Metallic shiny visual phenomena in a female patient with pancreatic cancer]. DIE OPHTHALMOLOGIE 2023; 120:309-313. [PMID: 35925323 DOI: 10.1007/s00347-022-01635-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Antonia Kowallick
- Klinik für Augenheilkunde, Universitätsmedizin Göttingen, Göttingen, Deutschland.
| | - Michael Koziolek
- Klinik für Nephrologie und Rheumatologie, Zentrum Innere Medizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Thomas Neß
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Nicolas Feltgen
- Klinik für Augenheilkunde, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Hans Hoerauf
- Klinik für Augenheilkunde, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Sebastian Bemme
- Klinik für Augenheilkunde, Universitätsmedizin Göttingen, Göttingen, Deutschland
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Alapati A, Cameron N, Gratton S, Stahl E, Champion M. Frosted branch angiitis presenting after a SARS-CoV-2 infection. J Ophthalmic Inflamm Infect 2022; 12:38. [PMID: 36355331 PMCID: PMC9648877 DOI: 10.1186/s12348-022-00316-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose To report a case of frosted branch angiitis presenting in a pediatric patient with unremarkable laboratory work-up apart from SARS-CoV-2 IgG antibodies. Observations Less than four weeks after a SARS-CoV-2 infection, a 10 year-old female presented to the emergency department with severe headache and intermittent fevers. During her hospital admission, the ophthalmology service was consulted for blurry vision. Subsequent eye examination revealed frosted branch angiitis. The patient initially received intravenous corticosteroids but was escalated to plasmapheresis to achieve resolution of her symptoms. Outpatient maintenance therapy consisted of an oral Prednisone taper and Infliximab infusion. Conclusion and importance This case represents a unique ocular manifestation of COVID-19, as recent SARS-CoV-2 was the sole identifiable cause of the patient’s frosted branch angiitis. Additionally, this patient required plasmapheresis to control disease progression.
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Treatment of Various Ocular Manifestation of Systemic Lupus Erythematosus with Therapeutic Plasma Exchange. J Clin Med 2022; 11:jcm11226632. [PMID: 36431109 PMCID: PMC9697686 DOI: 10.3390/jcm11226632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 10/24/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
The goal of this study is to describe a rare case of acute systemic lupus erythematosus (SLE) ocular involvement, followed by a rapid deterioration of the overall condition, and to then describe its successful treatment with therapeutic plasma exchange (TPE). In our case, a 21-year-old female, previously diagnosed with SLE, presented with a bilateral decreased vision for one week. Fundus examination and optical coherence tomography revealed subretinal fluid accumulation in both eyes and severe disc swelling with diffuse subretinal hemorrhages and perimacular whitening in the left eye. Despite systemic high-dose steroid therapy, the patient became worse, but immunosuppressive treatment was postponed due to fever and elevated serum leukocytes with the chance of systemic infection. She had undergone therapeutic plasma exchange (TPE) and was successfully treated. Preceding SLE ocular manifestation can be an indicator of the exacerbation of SLE, and TPE can be a treatment option for such progression.
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Understanding Ocular Findings and Manifestations of Systemic Lupus Erythematosus: Update Review of the Literature. Int J Mol Sci 2022; 23:ijms232012264. [PMID: 36293119 PMCID: PMC9603180 DOI: 10.3390/ijms232012264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/20/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease. Up to one-third of patients suffering from SLE have various ocular manifestations. The ocular findings may represent the initial manifestation of the systemic disease and may lead to severe ocular complications, and even loss of vision. Ocular manifestations are often associated with degree of systemic inflammation, but also can precede the occurrence of systemic symptoms. Early diagnosis and adequate management of patients with SLE are crucial and require cooperation between various specialists. Proper preparation of ophthalmologists can help to differentiate between complication of SLE and other ocular disorders. New therapies for SLE are promising for potential benefits, however, ocular side effects are still unknown.
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Mehta S, Mehta H. Optical Coherence Tomography-Based Diagnosis and Monitoring of Systemic Lupus Erythematosus-Associated Choroidopathy. Cureus 2022; 14:e29432. [PMID: 36312628 PMCID: PMC9595222 DOI: 10.7759/cureus.29432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/24/2022] Open
Abstract
A 55-year-old female presented with bilateral lower limb swelling and facial swelling along with a decreased frequency of micturition. Baseline investigations revealed an elevated serum creatinine and blood urea nitrogen. Subsequent investigations revealed a positive antinuclear antibodies (ANA) +++ (titer 1:10,000, serum immunofluorescence method) and positive anti-double-stranded DNA (dsDNA) testing. A detailed ophthalmic evaluation was performed. Her visual acuity was 6/36 improving to 6/18 in either eye. The near vision was found to be N36 without any further improvement. A dilated fundus examination revealed multiple yellowish lesions throughout the posterior pole consistent with pockets of subretinal fluid in the right eye. A swept-source optical coherence tomography (OCT) was performed that revealed the presence of fluid in both the intraretinal and subretinal spaces. A bacillary layer detachment, with the accumulation of fluid in the intraretinal space, was noted. Similar fundus findings were seen in the left eye. A decision was made to employ plasmapheresis (PLEX) along with her routine thrice-weekly hemodialysis. Additionally, the systemic steroids were continued. At her third follow-up (day 22), her vision had improved to 6/9 unaided bilaterally and to N6 with the appropriate correction. There was a near-complete regression of the exudative retinal detachments bilaterally with pigmentary changes. The OCT scans revealed significant regression of the serous retinal and retinal pigment epithelium (RPE) detachments with a thin rim of residual subretinal fluid. Fundus examination and OCT studies established the diagnosis of systemic lupus erythematosus (SLE) choroidopathy and guided its further management with systemic immunosuppression, hemodialysis and plasmapheresis. There was a rapid resolution of the retinal and choroidal findings with visual recovery over the next month.
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Preble JM, Lin X. Plasmapheresis as a viable treatment option for scleritis. Am J Ophthalmol Case Rep 2022; 27:101627. [PMID: 35782168 PMCID: PMC9243044 DOI: 10.1016/j.ajoc.2022.101627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/19/2022] [Accepted: 06/15/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose We describe a case and our experience with using plasmapheresis as a treatment for scleritis. Observations Treating relapsing autoimmune scleritis can be challenging when it inadequately responds to traditional therapy. Our patient could not receive non-steroidal anti-inflammatory therapy for her scleritis due to recent gastrointestinal surgery and previously failed multiple steroid sparing treatments due to intolerance. There was good initial control with high dose oral prednisone, however, the steroid could not be tapered to a safe dosage (<10 mg per day) without relapse. Therefore, we opted to treat our patient with plasmapheresis. Conclusions and Importance After undergoing plasmapheresis, our patient experienced total resolution of symptoms with corresponding clinical resolution of scleritis. Plasmapheresis derives great benefit by filtering circulating immune complexes. Although rarely used, plasmapheresis can be effective in treating non-infectious scleritis.
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Leone P, Prete M, Malerba E, Bray A, Susca N, Ingravallo G, Racanelli V. Lupus Vasculitis: An Overview. Biomedicines 2021; 9:biomedicines9111626. [PMID: 34829857 PMCID: PMC8615745 DOI: 10.3390/biomedicines9111626] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 12/21/2022] Open
Abstract
Lupus vasculitis (LV) is one of the secondary vasculitides occurring in the setting of systemic lupus erythematosus (SLE) in approximately 50% of patients. It is most commonly associated with small vessels, but medium-sized vessels can also be affected, whereas large vessel involvement is very rare. LV may involve different organ systems and present in a wide variety of clinical manifestations according to the size and site of the vessels involved. LV usually portends a poor prognosis, and a prompt diagnosis is fundamental for a good outcome. The spectrum of involvement ranges from a relatively mild disease affecting small vessels or a single organ to a multiorgan system disease with life-threatening manifestations, such as mesenteric vasculitis, pulmonary hemorrhage, or mononeuritis multiplex. Treatment depends upon the organs involved and the severity of the vasculitis process. In this review, we provide an overview of the different forms of LV, describing their clinical impact and focusing on the available treatment strategies.
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Affiliation(s)
- Patrizia Leone
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
| | - Marcella Prete
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
| | - Eleonora Malerba
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
| | - Antonella Bray
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
| | - Nicola Susca
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
| | - Giuseppe Ingravallo
- Section of Pathology, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy;
| | - Vito Racanelli
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
- Correspondence:
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de Andrade FA, Guimarães Moreira Balbi G, Bortoloti de Azevedo LG, Provenzano Sá G, Vieira de Moraes Junior H, Mendes Klumb E, Abramino Levy R. Neuro-ophthalmologic manifestations in systemic lupus erythematosus. Lupus 2017; 26:522-528. [DOI: 10.1177/0961203316683265] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect different ocular structures, such as cornea, conjunctiva, episclera, sclera, uveal tract, retina, optic nerve and vessels. Neuro-ophthalmologic manifestations in SLE include different degrees of involvement of retina, choroid and optic nerve. Retinal changes are one of the most common ocular involvements and are frequently used as clinical criteria for activity, even if isolated. Studies show that up to 29% of patients with active SLE manifest retinal disease. The exact prevalence of choroidal disease is unknown, but is thought to be less common than retinopathy, due to under-diagnosis. Optic nerve disease, represented by optic neuritis and anterior/posterior ischaemic optic neuropathy, affects approximately 1% of SLE patients. These ocular manifestations have been associated with neurologic flares, antiphospholipid antibodies, nephropathy, and increased mortality. The aim of this paper is to review the different aspects of neuro-ophthalmologic involvement in SLE. Since these manifestations are frequent and potentially severe, a multi-professional team approach is needed to investigate properly and provide early aggressive treatment in order to avoid visual sequelae.
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Affiliation(s)
- F A de Andrade
- Ophthalmologist, PGCM, Universidade do Estado do Rio de Janeiro, Brazil
| | - G Guimarães Moreira Balbi
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Brazil
| | - L G Bortoloti de Azevedo
- Department of Ophthalmology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Brazil
| | - G Provenzano Sá
- Department of Ophthalmology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Brazil
| | - H Vieira de Moraes Junior
- Department of Ophthalmology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Brazil
| | - E Mendes Klumb
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Brazil
| | - R Abramino Levy
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Brazil
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Ali Dhirani N, Ahluwalia V, Somani S. Case of combination therapy to treat lupus retinal vasculitis refractory to steroids. Can J Ophthalmol 2017; 52:e13-e15. [DOI: 10.1016/j.jcjo.2016.07.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 06/16/2016] [Accepted: 07/18/2016] [Indexed: 10/20/2022]
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Retinopathy in juvenile systemic lupus erythematosus successfully treated with plasma exchange. INDIAN JOURNAL OF RHEUMATOLOGY 2015. [DOI: 10.1016/j.injr.2014.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ischemic retinal vasculitis and its management. J Ophthalmol 2014; 2014:197675. [PMID: 24839552 PMCID: PMC4009272 DOI: 10.1155/2014/197675] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 02/21/2014] [Accepted: 03/25/2014] [Indexed: 12/14/2022] Open
Abstract
Ischemic retinal vasculitis is an inflammation of retinal blood vessels associated with vascular occlusion and subsequent retinal hypoperfusion. It can cause visual loss secondary to macular ischemia, macular edema, and neovascularization leading to vitreous hemorrhage, fibrovascular proliferation, and tractional retinal detachment. Ischemic retinal vasculitis can be idiopathic or secondary to systemic disease such as in Behçet's disease, sarcoidosis, tuberculosis, multiple sclerosis, and systemic lupus erythematosus. Corticosteroids with or without immunosuppressive medication are the mainstay treatment in retinal vasculitis together with laser photocoagulation of retinal ischemic areas. Intravitreal injections of bevacizumab are used to treat neovascularization secondary to systemic lupus erythematosus but should be timed with retinal laser photocoagulation to prevent further progression of retinal ischemia. Antitumor necrosis factor agents have shown promising results in controlling refractory retinal vasculitis excluding multiple sclerosis. Interferon has been useful to control inflammation and induce neovascular regression in retinal vasculitis secondary to Behçet's disease and multiple sclerosis. The long term effect of these management strategies in preventing the progression of retinal ischemia and preserving vision is not well understood and needs to be further studied.
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Ocular manifestations of systemic lupus erythematosus: a review of the literature. Autoimmune Dis 2012; 2012:290898. [PMID: 22811887 PMCID: PMC3395333 DOI: 10.1155/2012/290898] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 05/31/2012] [Indexed: 01/14/2023] Open
Abstract
About one-third of patients suffering from systemic lupus erythematosus have ocular manifestations. The most common manifestation is keratoconjunctivitis sicca. The most vision threatening are retinal vasculitis and optic neuritis/neuropathy. Prompt diagnosis and treatment of eye disease is paramount as they are often associated with high levels of systemic inflammation and end-organ damage. Initial management with high-dose oral or IV corticosteroids is often necessary. Multiple "steroid-sparing" treatment options exist with the most recently studied being biologic agents.
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Damato E, Chilov M, Lee R, Singh A, Harper S, Dick A. Plasma Exchange and Rituximab in the Management of Acute Occlusive Retinal Vasculopathy Secondary to Systemic Lupus Erythematosus. Ocul Immunol Inflamm 2011; 19:379-81. [DOI: 10.3109/09273948.2011.603069] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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16
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Bibliography. Current world literature. Neuro-ophthalmology. Curr Opin Ophthalmol 2007; 18:515-17. [PMID: 18163005 DOI: 10.1097/icu.0b013e3282f292cf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pagnoux C. Plasma exchange for systemic lupus erythematosus. Transfus Apher Sci 2007; 36:187-93. [PMID: 17368988 DOI: 10.1016/j.transci.2007.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2004] [Accepted: 01/05/2007] [Indexed: 11/16/2022]
Abstract
Efficacy of plasma exchange in patients with systemic lupus erythematosus has not been supported by the results of the first non-controlled and retrospective studies. Nonetheless, they remain relevant for some selected patients with life-threatening manifestations and/or severe therapy-resistant manifestations. They can be used as an adjuvant therapy in combination with corticosteroids and, when required, other immunosuppressant(s) for refractory renal disease, alveolar hemorrhage, some neuropsychiatric manifestations, thrombotic thrombocytopenic purpura, catastrophic antiphospholipid syndrome, hyperviscosity syndrome or symptomatic cryoglobulinemia. The use of newer technologies, like immunoadsorption, possibly in combination with recent biologics, might, in the future, offer some new perspectives for extracorporeal therapy of systemic lupus erythematosus.
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Affiliation(s)
- Christian Pagnoux
- Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université René Descartes, Paris, 27, rue du Faubourg Saint-Jacques, 75689 Paris Cedex 14, France.
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