Recurrent Optic Disc and Retinal Vasculitis in a Patient with Drug-Induced Urticarial Vasculitis

Abstract

The purpose of this study was to report recurrent optic disc and retinal vasculitis in a patient with drug-induced urticarial vasculitis. Complete ophthalmological examination including fluorescein angiography and visual field examination were done. A 53-year-old woman with recurrent painful urticarial skin lesions following trimethoprim sulfamethoxazole usage had the clinical and histopathological diagnosis of urticarial vasculitis. Two years after cutaneous manifestations, she began to notice visual disturbances in both eyes that recurred at 1-year intervals. Her ophthalmological findings were consistent with recurrent vasculitis of the optic nerve and retina. Treatment with high-dose corticosteroids and hydroxychloroquine resulted in the resolution of cutaneous and ocular manifestations. This patient demonstrates that recurrent occlusive vasculitis of the optic nerve and retina can occur in this rare disease. These patients should be examined periodically by ophthalmologists.

Urticarial lesions: If not urticaria, what else? The differential diagnosis of urticaria

“…8,102-105 Ocular involvement is severe, but infrequent, with conjunctivitis, recurrent uveitis, scleritis, or optic disc and retinal vasculitis occurring almost exclusively in patients with HUV. 5,9,[106][107][108] Therefore, UV associated with systemic involvement is more likely to be hypocomplementemic, but lower than normal levels of complement may not result following a single determination, and may require multiple testings. Patients with UV and mild or no systemic symptoms but hypocomplementemia need a careful follow-up.…”

Hidroxicloroquina: Del fármaco de herencia Inca hasta la inmunología moderna

“…37 La HCQ también se incluye en las recomendaciones terapéuticas de la vasculitis urticarial normo-o hipocomplementémica, ya sea en conjunto solo con antihistmínicos, o bien con otros tratamientos inmunosupresores; sin embargo, los esteroides siguen siendo requeridos. 38 Reporte de casos en las últimas tres décadas, han documentado que la HCQ ha sido efectiva hasta en un 50 % de los pacientes con vasculitis urticarial, e incluso en presencia de vasculitis retiniana asociada. 38 En arteritis de células gigantes, un doble ciego, aleatorizado y controlado de 64 pacientes, no reportó diferencia en recaídas entre pacientes tratados con HCQ 400 mg/d más esteroides, por 96 semanas, en comparación con aquellos casos que recibieron solo esteroides.…”

“…38 Reporte de casos en las últimas tres décadas, han documentado que la HCQ ha sido efectiva hasta en un 50 % de los pacientes con vasculitis urticarial, e incluso en presencia de vasculitis retiniana asociada. 38 En arteritis de células gigantes, un doble ciego, aleatorizado y controlado de 64 pacientes, no reportó diferencia en recaídas entre pacientes tratados con HCQ 400 mg/d más esteroides, por 96 semanas, en comparación con aquellos casos que recibieron solo esteroides. 37…”

Urticarial Vasculitis

“…There may be significant morbidity resulting from involvement of other organ systems. Rarely vasculitis can affect optic nerve and retina and hence can threaten vision [90]. All UV patients need to be evaluated ophthalmologically as 15-20% of all UV cases may have ocular involvement in the disease course [90].…”

“…Rarely vasculitis can affect optic nerve and retina and hence can threaten vision [90]. All UV patients need to be evaluated ophthalmologically as 15-20% of all UV cases may have ocular involvement in the disease course [90]. A patient with Muckle-Wells disease with associated UV developed sudden bilateral sensorineural hearing loss and had modest outcome following cochlear implantation [91].…”