Anterior ischemic optic neuropathy in a patient with Churg-Strauss syndrome.

Published on Dec 1, 2012in Korean Journal of Ophthalmology
· DOI :10.3341/KJO.2012.26.6.469
Ji Eun Lee3
Estimated H-index: 3
(Kosin University),
Seung Uk Lee6
Estimated H-index: 6
(Kosin University)
+ 2 AuthorsSang Joon Lee11
Estimated H-index: 11
(Kosin University)
We describe a patient with Churg-Strauss syndrome who developed unilateral anterior ischemic optic neuropathy. A 54-year-old man with a history of bronchial asthma, allergic rhinitis, and sinusitis presented with sudden decreased visual acuity in his right eye that had begun 2 weeks previously. The visual acuity of his right eye was 20 / 50. Ophthalmoscopic examination revealed a diffusely swollen right optic disc and splinter hemorrhages at its margin. Goldmann perimetry showed central scotomas in the right eye and fluorescein angiography showed remarkable hyperfluorescence of the right optic nerve head. Marked peripheral eosinphilia, extravascular eosinophils in a bronchial biopsy specimen, and an increased sedimentation rate supported the diagnosis of Churg-Strauss syndrome. Therapy with methylprednisolone corrected the laboratory abnormalities, improved clinical features, and preserved vision, except for the right central visual field defect. Early recognition of this systemic disease by ophthalmologists may help in preventing severe ocular complications.
📖 Papers frequently viewed together
8 Citations
1 Citations
28 Citations
#1Alfonse T. Masi (UIC: University of Illinois at Chicago)H-Index: 76
#2Gene G. Hunder (American College of Rheumatology)H-Index: 95
Last. Nathan J. Zvaifler (UCSD: University of California, San Diego)H-Index: 68
view all 16 authors...
Criteria for the classification of Churg-Strauss syndrome (CSS) were developed by comparing 20 patients who had this diagnosis with 787 control patients with other forms of vasculitis. For the traditional format classification, 6 criteria were selected: asthma, eosinophilia >10% on differential white blood cell count, mononeuropathy (including multiplex) or polyneuropathy, non-fixed pulmonary infiltrates on roentgenography, paranasal sinus abnormality, and biopsy containing a blood vessel with e...
2,209 CitationsSource
Ischemic optic neuropathy (ION), based on vascular anatomy of the optic nerve, pathogenesis and clinical picture, consists of two distinct entities: anterior (AION) and posterior (PION) ischemic optic neuropathies. AION is due to interference with posterior ciliary artery supply to the optic nerve head and retrolaminar part of the optic nerve; it initially presents with visual loss and optic disc edema which progresses to optic atrophy in a month or two. PION is due to occlusion of nutrient arte...
522 CitationsSource
#1Sofia Androudi (MEE: Massachusetts Eye and Ear Infirmary)H-Index: 32
#2Barbara Iaccheri (MEE: Massachusetts Eye and Ear Infirmary)H-Index: 13
Last. C. Stephen Foster (MEE: Massachusetts Eye and Ear Infirmary)H-Index: 104
view all 5 authors...
We describe a patient with Churg-Strauss syndrome (CSS) who developed bilateral chronic anterior uveitis and neuroophthalmologic manifestations 20 years after the onset of asthma and sinus disease. The patient was treated successfully with a combination of cyclophosphamide and prednisone, after other immunomodulatory strategies, aside from systemic prednisone, had failed.
8 CitationsSource
#1Brett Rosenblatt (Thomas Jefferson University)H-Index: 10
#2Rod Foroozan (Thomas Jefferson University)H-Index: 24
Last. Peter J. Savino (Thomas Jefferson University)H-Index: 75
view all 3 authors...
Abstract Objective To report asymptomatic optic disc edema in a patient with Churg–Strauss syndrome. Design Retrospective, observational case report. Methods Neuro-ophthalmic examination, sural nerve biopsy, and laboratory evaluation. Main outcome measures Visual acuity, funduscopy, automated perimetry, and histopathology of sural nerve biopsy. Conclusions Churg–Strauss syndrome may be associated with optic neuropathy. Careful ophthalmic evaluation may reveal signs of optic neuropathy before the...
11 CitationsSource
#1Claudio Vitali (UniPi: University of Pisa)H-Index: 48
Last. Marco Nardi (UniPi: University of Pisa)H-Index: 34
view all 5 authors...
• Background: It is well known that different types of eye involvement may develop during the course of systemic vasculitides. • Methods: We report here a case of Churg-Strauss syndrome (allergic granulomatous angiitis) characterized by the presence of multiple ophthalmological and neuro-ophthalmological lesions, i.e., mononeuritis of the fourth cranial nerve, multifocal choroidal ischaemia, and bilateral ischaemic optic neuropathy. • Results: Ischaemic lesions in the posterior ciliary plexus an...
38 CitationsSource
#1Shuzo ShintaniH-Index: 12
#2Shin TsuruokaH-Index: 4
Last. Masahito Yamada (Tokyo Medical and Dental University)H-Index: 66
view all 3 authors...
We present the rare case of a 62-year-old woman with Churg-Strauss syndrome associated with a left third nerve palsy and a mononeuritis multiplex. Cranial nerve palsies are unusual in patients with Churg-Strauss syndrome, and the most frequent cranial nerve lesion observed is an ischemic optic neuritis. Third nerve involvement secondary to vasculitis-induced ischemia is extremely rare in this disorder.
21 CitationsSource
#1Jorge C. KattahH-Index: 15
#2Georgia A. ChrousosH-Index: 12
Last. Martin P. KolskyH-Index: 12
view all 5 authors...
A patient with a history of chronic rhinitis, sinusitis, and bronchial asthma developed a unilateral anterior ischemic optic neuropathy and a mild sensory motor neuropathy as the initial manifestation of systemic vasculitis. We made a probable diagnosis of Churg-Strauss syndrome. Fluorescein angiography showed delayed choroidal perfusion in both eyes. Marked eosinophilia, increased sedimentation rate, and elevated perinuclear anti-neutrophil cytoplasmic antibody and anti-myeloperoxidase antibody...
39 CitationsSource
#1Alberts Ar (North Shore University Hospital)H-Index: 1
#2Lasonde RH-Index: 1
Last. Richard FurieH-Index: 42
view all 6 authors...
A 76-year-old woman hospitalized for treatment of an inferior vena cava thrombus was noted to have eosinophilia as well as asthma, peripheral neuropathy, jaw claudication and visual loss. Pathological review of a temporal artery biopsy revealed vasculitis with eosinophils but no giant cells. Treatment with high dose corticosteroids resulted in improvement of visual acuity from hand motion to 20/60. Whereas at least 6 cases of temporal artery involvement with Churg-Strauss syndrome have been repo...
30 Citations
#1Patrick D. Aiello (Mayo Clinic)H-Index: 1
#2James C. Trautmann (Mayo Clinic)H-Index: 12
Last. Gene G. Hunder (Mayo Clinic)H-Index: 95
view all 5 authors...
Purpose: The visual prognosis in giant cell arteritis (GCA) was evaluated over a 5year period. Methods: The authors reviewed the records of all patients with a diagnosis of GCA established at the Mayo Clinic over a 5-year period regarding visual status. Follow-up data for these patients were obtained 5 years later. Results: Of the 245 patients studied, 34 (14%) permanently lost vision because of GCA. In 32 of these patients, the visual deficit developed before glucocorticoid therapy for GCA was ...
249 CitationsSource
#1J F Acheson (St Thomas' Hospital)H-Index: 1
#2O C CockerellH-Index: 1
Last. M D SandersH-Index: 16
view all 4 authors...
A 44-year-old man with severe visual loss due to an acute bilateral sequential optic neuropathy is described, where the associated pulmonary disease and peripheral eosinophilia led to a diagnosis of Churg-Strauss syndrome (allergic angiitis). The mechanism of the optic neuropathy was most probably acute ischaemia of the anterior optic nerve due to direct involvement of the short posterior ciliary arteries by inflammatory disease of the vessel wall.
35 CitationsSource
Cited By5
Resume Les neuropathies optiques ischemiques font partie des principales causes de baisse d’acuite visuelle severe chez les sujets de plus de 50 ans. Elles constituent un ensemble d’entites variees aussi bien sur les plans cliniques, qu’etiologique ou therapeutique. Anatomiquement, il convient de distinguer les formes anterieures des formes posterieures. D’un point de vue etiologique, l’urgence resulte dans le diagnostic des formes arteritiques secondaires a une maladie de Horton, qui represente...
Summary Ischemic optic neuropathies are among the leading causes of severe visual acuity loss in people over 50 years of age. They constitute a set of various entities that are clinically, etiologically and therapeutically different. Anatomically, it is necessary to distinguish anterior and posterior forms. From an etiological point of view, the diagnosis of the arteritic form due to giant cell arteritis requires emergent management to prevent blindness and even death in the absence of prompt co...
1 CitationsSource
#1Sruti S. Akella (Montefiore Medical Center)H-Index: 2
#2Dianne M Schlachter (WSU: Wayne State University)H-Index: 1
Last. Anne Barmettler (Montefiore Medical Center)H-Index: 3
view all 4 authors...
PURPOSE: To review and summarize the clinical features, presentations, diagnostic modalities, and management of ophthalmic manifestations of eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg-Strauss Syndrome). METHODS: A systematic PubMed search of all English articles on EGPA with ophthalmic involvement was performed. Emphasis was placed on English-language articles, but any article with an abstract translated into English was also included. Only those cases that satisfied the...
6 CitationsSource
This paper summarizes the possible ocular manifestations of Churg-Straus syndrome (CCS) from the literature and presents an unusual case report from routine clinical practice with conjunctival granuloma, orbital pseudotumor and choroidal folds. The CSS is an ANCA-associated granulomatous vasculitis which can be manifested in various organs and represents a life-threatening situation for the patient. Ocular manifestations are rare and can spread to all segments of the eye and orbit. The most freq...
1 CitationsSource
#1A. Atili (Praxis)H-Index: 1
#2C. Richter (GAU: University of Göttingen)H-Index: 1
Last. M.P. Schittkowski (GAU: University of Göttingen)H-Index: 2
view all 5 authors...
Diese Arbeit fasst mogliche okulare Manifestationen bei Churg-Strauss-Syndrom (CCS) in der Literatur zusammen und prasentiert eine ungewohnliche Fallvorstellung aus dem klinischen Alltag mit konjunktivalen Granulomen, Pseudotumor orbitae und Aderhautfalten. CSS ist eine ANCA-assoziierte granulomatose Vaskulitis, die sich in verschiedenen Organen manifestieren kann und eine lebensbedrohliche Situation fur die Patienten darstellt. Okulare Manifestationen sind selten und konnen sich auf alle Segmen...
1 CitationsSource
#1Angelina Espino Barros Palau (UTMB: University of Texas Medical Branch)H-Index: 4
#1Angelina Espino Barros Palau (UTMB: University of Texas Medical Branch)H-Index: 1
Last. Andrew G. LeeH-Index: 63
view all 4 authors...
The aim of this study was to update the practicing ophthalmologist on the English-language neuro-ophthalmology literature from the prior year. This study is a review of English-language literature from August 1, 2012, to August 1, 2013. The authors searched PubMed articles published from August 1, 2012, to August 1, 2013, limited to English-language publications including original articles, review articles, and case reports and excluding letters to the editor, unpublished work, and abstracts. We...
2 CitationsSource