Cocaine Abuse as an Immunological Trigger in a Case Diagnosed with Eales Disease

Abstract

Background: Eales disease is a clinical syndrome affecting the mid-peripheral retina with an idiopathic occlusive vasculitis and possible subsequent retinal neovascularization. The disease can develop into visually threatening complications. Case Presentation: We report the case of a 40-year-old Caucasian male with a history of cocaine abuse who presented with blurred vision in the left eye (LE). Fundus examination showed vitreous hemorrhages, peripheral sheathing of venous blood vessels, areas of retinal neovascularization in the LE, and peripheral occlusive phlebitis in the right eye. The full serologic panel was negative except for the heterozygous mutation of factor V Leiden. Clinical and biochemical parameters suggested a diagnosis of Eales disease. Therapy with dexamethasone, 1 mg per kg per day, tapered down slowly over 4 months, and peripheral laser photocoagulation allowed a regression of clinical signs and symptoms. Conclusion: This case shows an uncommon presentation of Eales disease associated with cocaine abuse. Both cocaine abuse and a thrombophilic pattern, as cofactors, might have sensitized the retinal microcirculation on the pathogenetic route to this retinal pathology. Furthermore, in view of this hypothesis, a thorough ocular and general medical history investigating drug abuse and coagulation disorders is recommended for ophthalmologists in such cases.

A Review of Eales’ Disease and Mycobacterium tuberculosis

“…A recent case report of a patient diagnosed with Eales’ Disease with a history of cocaine abuse further introduced an alternative perspective on the pathophysiological route of Eales’ Disease [ 23 ]. While he tested negative on multiple tuberculosis tests, including the QuantiFERON TB-gold test, CT scan, and ACE test, he presented a family history of coagulation disorders and a 10-year history of cocaine abuse.…”

“…Iannetti et al hypothesized that cocaine abuse and coagulation disorders may serve as potential cofactors in triggering Eales’ Disease. The correlation between these cofactors and Eales’ Disease should be investigated for a comprehensive understanding of Eales’ Disease [ 23 ].…”