Diagnostic and Therapeutic Challenges

Abstract

An 11-year-old African American girl presented to the ophthalmology clinic with a 2-month history of progressive vision loss with no associated discomfort. Her medical history for the past 8 months is notable for fatigue, decreased appetite, a 10-pound weight loss, left-sided temporal headaches, shortness of breath, dyspnea on exertion, intermittent abdominal pain, diarrhea, muscle aches, night sweats, and subjective fevers. The patient's recent history is also notable for rhinorrhea and mild coughing productive of yellow sputum in the past 2 weeks, 3 episodes of emesis in the past week, and occasional erythematous and pruritic skin rashes on her trunk and limbs that began 8 months ago. The patient's medical history was otherwise noncontributory, with normal development, up-to-date on immunizations, and currently on no medications except for a daily multivitamin. The patient's family history was positive for thyroid disease and ankylosing spondylitis in distant relatives.

Occlusive retinal vasculitis following routine cataract surgery a

“…The diagnosis of isolated occlusive retinal vasculitis was made after clinically excluding infective and specific systemic and ocular inflammatory conditions, as supported by negative laboratory results . Systemic treatment was instigated as vision became threatened; however, immunosuppressive therapy, preferably steroid‐sparing to minimise the numerous adverse effects secondary to prolonged high‐dose steroid use, should not be started until an infective aetiology has been satisfactorily ruled out to avoid exacerbation of infection . Additionally, the patient must be closely monitored for relapse with titration of maintenance therapy in conjunction with the rheumatologist.…”