Arteritic Anterior Ischemic Optic Neuropathy in the Course of Giant Cell Arteritis After COVID-19

Abstract

Patient: Female, 69-year-old Final Diagnosis: Anterior ischemic neuropathy • giant cell arteritis Symptoms: Headache • tenderness • vision loss Medication: — Clinical Procedure: — Specialty: Ophthalmology Objective: Rare disease Background: Giant cell arteritis (GCA) is an inflammation of large vessels that affects the lining of the arteries and leads to vessel swelling and the eventual reduction of blood flow. This can result in ischemia of the optic nerve, which is known as arteritic anterior ischemic optic neuropathy (AAION). The present case seems noteworthy because the patient developed GCA with the ocular manifestation of AAION shortly after having COVID-19. Case Report: A 69-year-old woman was admitted to the Clinic of Ophthalmology after having COVID-19. She reported vision loss in the left eye, which appeared 2.5 weeks after a positive SARS-CoV-2 test. While in the hospital, she was diagnosed with AAION and GCA. The patient was treated with enoxaparin sodium, prednisone, and methotrexate. Three months after the hospitalization, the visual acuity of the left eye was limited to light perception, and optic nerve atrophy was reported. Conclusions: We would like to emphasize the role of SARS-CoV-2 infection as a possible risk factor for the onset of GCA and its ocular manifestations, such as AAION. However, further research is needed to determine the relationship between SARS-CoV-2 infection and GCA. Because some symptoms of the 2 diseases are similar, the diagnosing process might be long and challenging. The diagnosis of GCA should be made as soon as possible to avoid serious complications, such as bilateral vision loss.

Optic neuropathies post-Covid 19 - review

“…In the articles in literature, an accurate diagnosis of postcovid optic neuropathy was carried out through an ophthalmological examination, in some cases associated with a neurological examination [7][8][9]. Imaging studies such as optical coherence tomography (OCT) [5,7,9,10,12,13,15,17], computer tomography (CT) [15], angiofluorography (AFG) [2,11], magnetic resonance imaging (MRI) [3-5,7-10,16-18], ultrasonography of the retrobulbar arteries [2], as well as laboratory, immunological and serological analyses were used. In order to clarify the etiological diagnosis and establish differential diagnoses with other infectious or autoimmune diseases, the following inflammatory tests were performed: erythrocyte sedimentation rate (ESR), ferritin, LDH, fibrinogen, CRP [2,4,6,7,8,13], D-dimers [2,6,12,14,16,17] immunological tests: rheumatoid factor (RF) [2,4,6,7,8,11,13,14,15], antinuclear antibodies (ANA), antineutrophil cytoplasmic antibodies (ANCA) [6,7], anti-aquaporin 4 antibodies (AQP4) [6], anti MOG IgG, antibodies IgG and IgM SARS-CoV-2; anti neuromyelitis optica antibodies (NMO), serology for syphilis, tuberculosis, cytomegalovirus, Lyme disease, Ebstein Barr virus, Herpes Simplex, human immunodeficiency virus, Borellia, hepa...…”

“…21 patients affected by ON in the Covid-19 disease, 11 women and 10 men, were mentioned in the cited publications. The associated comorbidities were HT associated with DM [2,8,17], balanced, well controlled [2,17] or imbalanced [8] DM. Only one new case was diagnosed with DM [6].…”

“…From a clinical point of view, the optic neuropathies described by the authors were: retrobulbar (posterior) optic neuropathy in more cases [7,16,18], only one associated with MOG+ [7], anterior optic neuropathy (papillitis) [6,7], AION [2,13,14,18], from which one AAION [2] and the others NAION [13,14,18], one being related to pronation in an OTI patient with ARDS [14], neuroretinitis [18], suggested by the eye fundus with papillary edema with star-shaped associated with star-shaped macular exudates. It is difficult to specify the triggering mechanism of inflammatory optic neuropathies or ischemic optic neuropathies.…”

“…In the case of papillitis, the evolution was good according to the ON treatment trial (ONTT) scheme [6] or with preservation of VA, but OCT changes at the level of the retinal nerve fiber layer (RNFL) [7]. Despite the corticotherapy treatment, in many cases, the evolution towards optic atrophy was inevitable [2,5,[10][11][12][13][14], with irreversible vision loss.…”

“…Regarding the form of the Covid disease, most of the neuropathies described by the authors were found in the mild forms of the disease [2][3][4][5]7,[15][16][17][18], but there were also some moderate forms [6,8,13] requiring oxygen and general treatment with antibiotics and anticoagulants. In several other cases, the Covid disease took on serious forms, with severe complications [9][10][11][12] and hospitalization in the intensive care unit (ICU) and even OTI [12].…”