Neuropatia óptica auto-imune: relato de caso

Cardoso, Laura Emilia Monteiro Bigélli; Zacharias, Leandro Cabral; Monteiro, Mário Luiz Ribeiro

doi:10.1590/s0004-27492006000400026

Cited by 4 publications

(5 citation statements)

References 11 publications

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“…It responds well to corticosteroid therapy and can become steroid dependent, unlike our patient who did not respond to massive doses in the treatment. Another difference is the symptoms, where the autoimmune optic neuritis usually is not accompanied by orbital pain (12,13) . This case shows the value of the ocular complaints in systemic diseases.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune optic neuropathy as the first manifestation of systemic lupus erythematosus

Amigo¹,

Barbara²,

Ghirelli³

2012

Rev. bras.oftalmol.

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We described a 35 years old female patient with bilateral visual loss and pain on eye movement, mild papillary edema in acute phase, arcuate scotoma and complementary test positive for antinuclear antibodies that did not respond to corticosteroid therapy. The lack of clinical criteria for systemic lupus erythematosus (SLE) didn't prevent the institution of the specific treatment with corticosteroids and azathioprine. After seven months the diagnosis was made after a skin manifestation of the disease. This case shows the value of the ocular complaints in systemic diseases. And how the ophthalmologic exam can help the clinician elaborating a diagnosis. It is also very important for ophthalmologists and rheumatologists due to the fact that it calls the attention to another diagnostic hypothesis in patients with nonspecific optic neuritis, even with inconclusive laboratory tests. Maybe some ocular findings deserve to be included to the diagnostic criteria already established for SLE.Keywords: Optic neuritis/etiology; Optic nerve diseases/etiology; Lupus erythematosus, systemic; Collagen diseases; Case reports RESUMO Descrevemos caso de um paciente de 35 anos do sexo feminino, com perda visual bilateral associada à dor à movimentação ocular, edema papilar moderado na fase aguda, escotoma arqueado e exame complementar positivo para anticorpos antinucleares, que não responderam à terapia com corticosteróides. A falta de critérios clínicos para o lúpus eritematoso sistêmico (LES) não impediu a instituição do tratamento específico com corticosteróides e azatioprina. Depois de sete meses, o diagnóstico foi feito após uma manifestação da doença de pele. Este caso mostra o valor das queixas oculares em doenças sistêmicas e como o exame oftalmológico pode ajudar o clínico na elaboração de um diagnóstico. Também é muito importante para oftalmologistas e reumatologistas, devido ao fato de que chama a atenção para outra hipótese diagnóstica em pacientes com neurite óptica não-específica, mesmo com os testes laboratoriais conclusivos. Talvez alguns achados oculares merecem ser incluídos com os critérios de diagnóstico já estabelecido para o LES.Descritores: Neurite óptica/etiologia; Doenças do nervo óptico/etiologia; Lupus eritematoso sistêmico; Doenças do colágeno; Relatos de casos 1

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Section: Discussionmentioning

confidence: 99%

Autoimmune optic neuropathy as the first manifestation of systemic lupus erythematosus

Amigo¹,

Barbara²,

Ghirelli³

2012

Rev. bras.oftalmol.

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“…In particular, the female/male ratio was 20.8, while the mean age of adult SS patients is 48 ± 13.2 years, consistently with recent SS epidemiological findings [ 102 , 103 ]. Four cases of young girls (range 8–11 years) were also reported, all affected by optic neuritis and two by CNS involvement [ 34 , 45 , 63 , 67 ]. Of interest, considering the 75 cases with available data, the first episode of cranial neuritis was contemporary to SS diagnosis in 40% of patients, while neuritis proceeded in 24% (range 1–35 years), or followed SS diagnosis (range 1–14 years) in 36%, respectively.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…The review of the literature revealed that optic neuritis represents the 46.4% (124/267) of cranial neuritis in SS patients [ 7 , 18 , 19 , 24 , 34 , 36 , 43 – 45 , 49 , 54 – 56 , 59 , 63 , 65 – 68 , 70 , 72 – 75 , 77 – 81 , 83 , 85 – 93 , 95 – 97 , 100 , 104 ]; it is often bilateral with contemporary [ 65 , 67 , 68 , 70 , 85 , 89 , 95 , 97 ] or sequential [ 36 , 63 ] occurrence. In a few cases, neuritis was associated with CNS involvement, such as brain vasculitis [ 34 , 77 ], acute transverse myelopathy [ 43 , 67 ], myelitis [ 77 , 80 , 83 , 90 ], aseptic meningitis [ 70 ], or multiple sclerosis-like features [ 80 , 91 ].…”

Section: Review Of the Literaturementioning

confidence: 99%

“…In a few cases, neuritis was associated with CNS involvement, such as brain vasculitis [ 34 , 77 ], acute transverse myelopathy [ 43 , 67 ], myelitis [ 77 , 80 , 83 , 90 ], aseptic meningitis [ 70 ], or multiple sclerosis-like features [ 80 , 91 ]. Response to treatment was frequently effective, especially with the use of immunosuppressors; however, an irreversible visual impairment was occasionally reported [ 45 , 63 , 79 , 95 ]. From a pathophysiological point of view, optic neuropathy may be related to immune-mediated small vessel vasculitis [ 70 ]; otherwise, it may be due to demyelinating disease being included or not in the neuromyelitis optica spectrum disorder [ 91 ].…”

Section: Review Of the Literaturementioning

confidence: 99%

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Neurologic Complications Associated with Sjögren’s Disease: Case Reports and Modern Pathogenic Dilemma

Colaci

Cassone

Manfredi

et al. 2014

Case Reports in Neurological Medicine

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Objectives. Sjögren's syndrome (SS) may be complicated by some neurological manifestations, generally sensory polyneuropathy. Furthermore, involvement of cranial nerves was described as rare complications of SS. Methods. We reported 2 cases: the first one was a 40-year-old woman who developed neuritis of the left optic nerve as presenting symptom few years before the diagnosis of SS; the second was a 54-year-old woman who presented a paralysis of the right phrenic nerve 7 years after the SS onset. An exhaustive review of the literature on patients with cranial or phrenic nerve involvements was also carried out. Results. To the best of our knowledge, our second case represents the first observation of SS-associated phrenic nerve mononeuritis, while optic neuritis represents the most frequent cranial nerve involvement detectable in this connective tissue disease. Trigeminal neuropathy is also frequently reported, whereas neuritis involving the other cranial nerves is quite rare. Conclusions. Cranial nerve injury is a harmful complication of SS, even if less commonly recorded compared to peripheral neuropathy. Neurological manifestations may precede the clinical onset of SS; therefore, in patients with apparently isolated cranial nerve involvement, a correct diagnosis of the underlying SS is often delayed or overlooked entirely; in these instances, standard clinicoserological assessment is recommendable.

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“…1 This visual abnormality may be associated with infections, vaccinations, drugs and autoimmune diseases, particularly multiple sclerosis (MS) and neuromielitis optic (NMO). 2,3 Of note, ON was rarely reported in juvenile idiopathic arthritis (JIA) patients, particularly in those under tumor necrosis factor alpha (TNF-␣) blockage. [3][4][5][6] However, to our knowledge, the prevalence of ON in JIA population has not been studied.…”

Section: Introductionmentioning

confidence: 99%

Optic neuritis in juvenile idiopathic arthritis patient

Lourenço

Buscatti

Lourenço

et al. 2014

Revista Brasileira de Reumatologia (English Edition)

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r e v b r a s r e u m a t o l . 2 0 1 4;5 4(6):486-489 REVISTA BRASILEIRA DE REUMATOLOGIA w w w . r e u m a t o l o g i a . c o m . b r Juvenile idiopathic arthritis Anti-aquaporin 4 antibody a b s t r a c tOptic neuritis (ON) was rarely reported in juvenile idiopathic arthritis (JIA) patients, particularly in those under anti-tumor necrosis factor alpha blockage. However, to our knowledge, the prevalence of ON in JIA population has not been studied. Therefore, 5793 patients were followed up at our University Hospital and 630 (11%) had JIA. One patient (0.15%) had ON and was reported herein. A 6-year-old male was diagnosed with extended oligoarticular JIA, and received naproxen and methotrexate subsequently replaced by leflunomide. At 11 years old, he was diagnosed with aseptic meningitis, followed by a partial motor seizure with secondary generalization. Brain magnetic resonance imaging (MRI) and electroencephalogram showed diffuse disorganization of the brain electric activity and leflunomide was suspended.Seven days later, the patient presented acute ocular pain, loss of acuity for color, blurred vision, photophobia, redness and short progressive visual loss in the right eye. A fundoscopic exam detected unilateral papilledema without retinal exudates. Orbital MRI suggested right ON. The anti-aquaporin 4 (anti-AQP4) antibody was negative. Pulse therapy with methylprednisolone was administered for five days, and subsequently with prednisone, he had clinical and laboratory improvement. In conclusion, a low prevalence of ON was observed in our JIA population. The absence of anti-AQP4 antibody and the normal brain MRI do not exclude the possibility of demyelinating disease associated with chronic arthritis. Therefore, rigorous follow up is required.

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Neuropatia óptica auto-imune: relato de caso

Cited by 4 publications

References 11 publications

Autoimmune optic neuropathy as the first manifestation of systemic lupus erythematosus

Autoimmune optic neuropathy as the first manifestation of systemic lupus erythematosus

Neurologic Complications Associated with Sjögren’s Disease: Case Reports and Modern Pathogenic Dilemma

Optic neuritis in juvenile idiopathic arthritis patient

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