Title

OPTICAL NEURITIS SECONDARY TO CROHN'S DISEASE

Introduction

Crohn's disease (CD) is a chronic, recurrent and remitting inflammatory bowel disease, which may present, in addition to classic gastrointestinal manifestations, extra-intestinal symptoms, including peripheral and central neuropathies. Although rare, cases of optic neuritis have been described in these patients, causing total or partial loss of vision.

Methods

A review of the patient's medical record was performed together with a literature review on the correlation of Crohn's disease and ocular manifestations such as optic neuritis.

Results

Female, fifth decade of life, complaint of gradual visual blurring for 15 days in the left eye (LE), despite visual acuity (AV) 20/20 in both eyes (BE) in the first assessment, plus retinal mapping examination showing papilla edema with disc blurring. In addition presents Crohn's disease with rectovaginal fistula, and a history of infliximab use in the past but abandoned treatment. Brain magnetic ressonance without alterations. Laboratory screening tests for negative infectious uveitis. The angiofluoresceinography (PA) exam showed early optic nerve hyperfluorescence. The patient showed improvement in VA with the advent of pulsetherapy, however, after two weeks without the use of maintenance corticosteroids, she had a relapse of symptoms and, on examination, maintained papilla edema. Then oral prednisone 40mg / day was reintroduced with complete improvement of visual symptoms in a few weeks.

Discussion

Neurovisual involvement in inflammatory bowel diseases is rare, although probably underreported. Therefore, it is necessary to pay attention to this differential diagnosis so that the appropriate treatment is not delayed, since it is extremely important to control the underlying disease to prevent recurrence of ocular symptoms and, in turn, achieve satisfactory visual results.

Keywords

NEURITIS, CROHN`S DESEASE, RETINAL, INFLAMMATORY BOWEL, PULSETHERAPY, STEROIDS, PAPILLA EDEMA

Area

CLINICAL CASE

Authors

ANA PAULA BORTOLOTTO, GRACE KELLY PELICIONI DE CASTRO, MARCELO LUIZ GEHLEN, DEBORAH FISCHER, CARLOS AUGUSTO MOREIRA JUNIOR, CARLOS AUGUSTO MOREIRA NETO, CAIO CESAR GAZIM, CAROLINE CORDEL RINGVELSKI