Title

WEGENER'S GRANULOMATOSIS ASSOCIATED TO UNILATERAL RETINAL VASCULITIS WITH OCCLUSIVE VASCULOPATHY AND SECONDARY MACULAR EDEMA: A CASE REPORT

Introduction

Wegener's granulomatosis (WG) is a vasculitis of small and medium vessels with an incidence of ocular involvement of 50-60%.

Methods

Clinical case description of a patient with WG retinal vasculitis through analysis of medical records and complementary exams.

Results

JCSB, male, 55 years old, presented initial complaint of recurrent conjunctivitis, urinary infections and recurrent otitis, associated with joint symptoms for approximately 04 months. On clinical examination, multiple reactive arthritis in the left knee, wrists, pasterns and proximal interphalangeal joints, significant bilateral conjunctival hyperemia. Laboratory tests: PCR and ESR increased, C-ANCA and Anti-PR3 positive. Serologies, FR and HLA-B27 negative. EAS with proteinuria 1 + / 4 and significant hematuria. After the hypothesis of WG, pulse therapy with cyclophosphamide and methylprednisolone was performed. Diagnosed with severe retinal vasculitis in the left eye (OS), retinal venous thrombosis and secondary macular edema, he used anti-angiogenic for 3 months. In a new consultation, angiofluoresceinography showed ischemia in the lower quadrant of OS and OCT of macula with thickness 315, showing edema of the lower macula, indicating a new application of anti-angiogenic and argon laser in OS. New macula OCT showed 276 thickness and improvement of secondary macular edema in OS. Best corrected visual acuity for 20/20 in the right eye (OD) and 20/50 in OS. Currently, retinal vasculitis is in resolution and under control and he is being treated only for secondary macular edema.

Discussion

Retinal vasculitis by WG with macular edema, retinal venous thrombosis is rare and with poor prognosis. Combined treatment of cyclophosphamide and corticosteroids has achieved good results in the remission of most patients and is recommended for more severe situations as in the case reported. In addition, argon laser and anti-angiogenic treatment were performed to resolve macular edema. After treatment, the patient evolved with vasculitis control.

Keywords

Wegener's granulomatosis; Vasculitis; Retinopathy

Area

CLINICAL CASE

Authors

THAYS DE OLIVEIRA CARMO BORGES DE MELO, IRINEU RIBEIRO DE MELO JUNIOR, ISADORA FERRO NOGUEIRA, VICTORIA DE OLIVEIRA CARMO BORGES, Sarah Fumian Milward de Azevedo, Vanessa Mendonça Rocha