Central retinal vein occlusion in temporal arteritis: red sign or red herring?

Central retinal vein occlusion in temporal arteritis: red sign or red herring? Mortality associated with GCA 38 Redelings MD, Wise M, Sorvillo F. Using multiple cause- 39 Barrier J, Pion P, Massari R et al. Epidemiologic approach of-death data to investigate associations and causality to Horton’s disease in the department of Loire-Atlantique. between conditions listed on the death certificate. Am J 110 cases in 10 years (1970-1979) [French]. Rev Med Epidemiol 2007;166:1048. Interne 1982;3:1320. Rheumatology 2018;57:1055 doi:10.1093/rheumatology/kex479 Clinical Vignette Advance Access publication 17 January 2018 Central retinal vein occlusion in temporal arteritis: FIG.1 Retinal imaging demonstrating right eye central red sign or red herring? vein occlusion A 74-year-old female with biopsy-proven temporal arteritis in remission after prednisone treatment for 18 months pre- sented with blurred vision. Fluorescein angiography re- vealed unilateral central retinal vein occlusion (CRVO). Elevated CRP was noted. Her cardiovascular risks factors included past smoking and advanced age. Thrombophilia assessment was negative. Three months later she complained of arthralgias. Inflammation markers were elevated. CT with angiography revealed evidence of extensive large vessel vasculitis of the thoracic/abdominal aorta and its branches. Steroid treatment was reintroduced, MTX and AZA initiated. CRVO is known to be related to cardiovascular risk fac- tors, hypercoagulable states or intraocular hypertension, but not to GCA. Various CRVO scenarios have been re- ported in the context of GCA—possible association to central retinal artery occlusion or as a presenting as well as a late event of GCA—but a constant feature remains, elevated sedimentation rate [1]. Chronic inflammation af- fecting endothelial function may explain the tendency for venous thrombosis [2]. Our case highlights that occurrence of CRVO in elderly (A) An infrared image of the right eye posterior pole people, in the presence of elevated inflammation param- demonstrating a central retinal vein occlusion. Note that the eters, should suggest the diagnosis of GCA. The impact of optic disc is obscured by oedema and haemorrhages early steroid treatment on visual acuity in this context is (arrow), the dilated and torturous veins (arrow head). (B) An still unknown. early phase fundus fluorescein angiography demonstrating Funding: No specific funding was received from any delayed retinal venous filling as well as extensive hypo- funding bodies in the public, commercial or not-for-profit fluorescence lesions around the optic disc correlating to sectors to carry out the work described in this article. retinal haemorrhages (*). (C) CT with angiography shows the enlarged wall of the thoracic aorta (arrow). Disclosure statement: The authors have declared no conflicts of interest. 1 1 1 of Medicine, Technion, Haifa, Israel. Lisa Kaly , Gleb Slobodin , Doron Rimar , 1 1 E-mail: lisakaly@yahoo.fr Michael Rozenbaum , Nina Boulman , 2 1 3 Shira Ginsberg , Abed Awisat , Karin Zilber , 1 1 Haya Hussein and Izthak Rosner References Rheumatology Department, Bnai Zion Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Internal 1 Zaldivar RA, Calamia KT, Bolling JP. Retinal vein occlusion Medicine/Rheumatology Department, Bnai Zion Medical in giant cell arteritis [abstract]. Invest Ophthalmol Vis Sci Center and Internal Medicine/Rheumatology, Hillel Yaffe 2004;45:1589. Medical Center, Haifa, Israel 2 Ly KH, Liozon E, Dalmay F et al. Venous thrombosis in Correspondence to: Lisa Kaly, Rheumatology Department, patients with giant cell arteritis: Features and outcomes in Bnai Zion Medical Center, Ruth and Bruce Rappaport Faculty a cohort study. Joint Bone Spine 2017;84:32326. ! The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com https://academic.oup.com/rheumatology 1055 Downloaded from https://academic.oup.com/rheumatology/article-abstract/57/6/1055/4816238 by Ed 'DeepDyve' Gillespie user on 17 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Rheumatology Oxford University Press

Central retinal vein occlusion in temporal arteritis: red sign or red herring?

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Oxford University Press
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© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com
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1462-0324
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1462-0332
D.O.I.
10.1093/rheumatology/kex479
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Abstract

Mortality associated with GCA 38 Redelings MD, Wise M, Sorvillo F. Using multiple cause- 39 Barrier J, Pion P, Massari R et al. Epidemiologic approach of-death data to investigate associations and causality to Horton’s disease in the department of Loire-Atlantique. between conditions listed on the death certificate. Am J 110 cases in 10 years (1970-1979) [French]. Rev Med Epidemiol 2007;166:1048. Interne 1982;3:1320. Rheumatology 2018;57:1055 doi:10.1093/rheumatology/kex479 Clinical Vignette Advance Access publication 17 January 2018 Central retinal vein occlusion in temporal arteritis: FIG.1 Retinal imaging demonstrating right eye central red sign or red herring? vein occlusion A 74-year-old female with biopsy-proven temporal arteritis in remission after prednisone treatment for 18 months pre- sented with blurred vision. Fluorescein angiography re- vealed unilateral central retinal vein occlusion (CRVO). Elevated CRP was noted. Her cardiovascular risks factors included past smoking and advanced age. Thrombophilia assessment was negative. Three months later she complained of arthralgias. Inflammation markers were elevated. CT with angiography revealed evidence of extensive large vessel vasculitis of the thoracic/abdominal aorta and its branches. Steroid treatment was reintroduced, MTX and AZA initiated. CRVO is known to be related to cardiovascular risk fac- tors, hypercoagulable states or intraocular hypertension, but not to GCA. Various CRVO scenarios have been re- ported in the context of GCA—possible association to central retinal artery occlusion or as a presenting as well as a late event of GCA—but a constant feature remains, elevated sedimentation rate [1]. Chronic inflammation af- fecting endothelial function may explain the tendency for venous thrombosis [2]. Our case highlights that occurrence of CRVO in elderly (A) An infrared image of the right eye posterior pole people, in the presence of elevated inflammation param- demonstrating a central retinal vein occlusion. Note that the eters, should suggest the diagnosis of GCA. The impact of optic disc is obscured by oedema and haemorrhages early steroid treatment on visual acuity in this context is (arrow), the dilated and torturous veins (arrow head). (B) An still unknown. early phase fundus fluorescein angiography demonstrating Funding: No specific funding was received from any delayed retinal venous filling as well as extensive hypo- funding bodies in the public, commercial or not-for-profit fluorescence lesions around the optic disc correlating to sectors to carry out the work described in this article. retinal haemorrhages (*). (C) CT with angiography shows the enlarged wall of the thoracic aorta (arrow). Disclosure statement: The authors have declared no conflicts of interest. 1 1 1 of Medicine, Technion, Haifa, Israel. Lisa Kaly , Gleb Slobodin , Doron Rimar , 1 1 E-mail: lisakaly@yahoo.fr Michael Rozenbaum , Nina Boulman , 2 1 3 Shira Ginsberg , Abed Awisat , Karin Zilber , 1 1 Haya Hussein and Izthak Rosner References Rheumatology Department, Bnai Zion Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Internal 1 Zaldivar RA, Calamia KT, Bolling JP. Retinal vein occlusion Medicine/Rheumatology Department, Bnai Zion Medical in giant cell arteritis [abstract]. Invest Ophthalmol Vis Sci Center and Internal Medicine/Rheumatology, Hillel Yaffe 2004;45:1589. Medical Center, Haifa, Israel 2 Ly KH, Liozon E, Dalmay F et al. Venous thrombosis in Correspondence to: Lisa Kaly, Rheumatology Department, patients with giant cell arteritis: Features and outcomes in Bnai Zion Medical Center, Ruth and Bruce Rappaport Faculty a cohort study. Joint Bone Spine 2017;84:32326. ! The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com https://academic.oup.com/rheumatology 1055 Downloaded from https://academic.oup.com/rheumatology/article-abstract/57/6/1055/4816238 by Ed 'DeepDyve' Gillespie user on 17 June 2018

Journal

RheumatologyOxford University Press

Published: Jan 17, 2018

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