Macular Infarction Associated with Reactive Arthritis

Abstract

A 53-year-old woman visited the Department of Rheumatology with a chief complaint of a 3-day history of fever and chills and also presented with pain occuring in both knees at the time of outpatient visit. Based on rheumatologic and hematological lab studies, ultrasonography, and a needle aspiration biopsy of the articular cavity, the patient was diagnosed with reactive arthritis. On hospitalization day 3, consultation with the Department of Ophthalmology was requested regarding decreased visual acuity lasting for 3 days. Upon ophthalmologic examination, the corrected visual acuity was 0.1 in the right eye and 0.05 in the left eye. Upon slit lamp microscopy, there were no abnormal findings in the anterior segment. Upon fundus examination, however, there were yellow-white lesions in the macular area of both eyes. Fluorescein angiographywas performed to assess the macular lesions, and the findings were suggestive of macular infarction in both eyes. Due to a lack of other underlying disease, a past surgical history, and a past history of drug administration, the patient was diagnosed with macular infarction in both eyes associated with reactive arthritis. To date, there have been no other such cases reported. In a patient with reactive arthritis, we experienced a case of macular infarction in both eyes, which occurred without association with a past history of specific drug use or underlying disease. Herein, we report our case, with a review of the literature.

Bilateral retinal detachment in reactive arthritis: coincidence or association?

“…However, there may in fact be an association between the two disorders that may be pathophysiologically explained by immunological mechanisms [3,4]. Of interest, other ocular complications of reactive arthritis like macular infarctions and vitris with transient white retinal spots have been described [5,6].…”

Bilateral multifocal posterior pole lesions in Reiter syndrome

“…Kim et al 6 described a case of bilateral visual loss (6/60 right eye and 6/120 left eye) from macular infarct in a 53-year-old woman 3 days after presenting with fever, chills and bilateral knee pain. Conway et al 7 reported a patient with uveitis that progressed to involve the posterior segment as two transient white retinal spots.…”

“…Major ocular manifestations have included mild, symmetric and bilateral conjunctivitis with a mucopurulent discharge and a papillary or follicular reaction, and anterior mild non-granulomatous uveitis with fine-sized to medium-sized white keratic precipitates 1 – 10. Scleritis, episcleritis,3 keratitis,11 disc oedema, retinal oedema, retinal vasculitis6 and retinal detachment1 2 have also been reported. We present the retinal findings in a rheumatologist with retinal manifestations from Reiter syndrome.…”

Ocular Complications in Sickle Cell Disease: A Neglected Issue

“…Macular infarction due to SCD has been documented using fluorescein angio-graphy, electroretinography, and histopathologic examination [43]. In SCD, sickle-shaped RBCs increase the blood viscosity and thereby can trigger vascular obstruction, ischemia, hypoxia, and tissue necrosis [44] [45]. Mathew et al observed areas of retinal thinning in the temporal macular area in 44% of the SCD eyes [46].…”