Okołożylne zapalenie naczyń siatkówki jako objaw zespołu antyfosfolipidowego – opis przypadku
Periphlebitis of the Retinal Vessels as a Symptom of Antiphospholipid Syndrome – Case Report
Anna Murawska, Katarzyna Załęska, Leoplod Glasner
Katedra i Klinika Okulistyki Gdańskiego Uniwersytetu Medycznego
Kierownik: prof. dr hab. n. med Krystyna Raczyńska
Summary: Introduction: The antiphospholipid syndrome – a synonim of the Huges complex, antiphosholipid syndrome (APS) is a disease caused by the action of antibodies, directed against the protein-phospholipid complexes. Its symptoms include venous thrombosis or artery thrombosis as well as obstetrician failures. The ophthalmological symptoms are associated with APS in 33-73% of cases and they may be the first manifestation of the disease. During the disease of the antiphospholipid complex venous thrombosis and inflammation of the retinal vessels may occur.
Purpose: In the study, case of a 36-year-old patient was presented with periphlebitis of the retinal vessels in the course of the antiphospholipid complex and diagnostic difficulties associated with it.
Material: A 36-year-old patient, healthy woman, reported in 2001 to the ophthalmological emergency unit due to the vision deterioration in and pain during left eyeball movements. Posterior optic nerve neuritis was suspected in the course of multiple sclerosis. In 2006, a sudden vision deterioration in both eyes occurred again. On the basis of additional tests results, bilateral tinica mucosa inflammation diagnosis was made with retinal vessels periphlebitis due to toxoplasmosis. The patient was consulted in the Department of Connective Tissues Diseases. Based on careful medical interview and complete immunological diagnostics, the retinal vessels periphlebitis was recognized due to antiphospholipid syndrome.
Methods: The observation period of the patient was almost 10 years (2001 – 2011). During the diagnostics process following tests were performed: visual evoked potentials, MRI of the head, static perimetry, fluorescein angiography, coherent optical tomography, antibodies, i.a. against toxoplasmosis, boreliosis and antiphospholipid antibodies. The following treatment was applied: steroids-therapy, immunosuppressive and anti-coagulative medicines.
Results: After 5 years from the first ophthalmological symptoms onset, final diagnosis was made. The patient is under permanent ophthalmologic care.
1. Ophthalmologic symptoms, being the first ones of the antiphospholipid syndrome played an important role disease diagnosis.
2. Due to the atypical clinical course, immunological examinations played a decisive role in recognizing the disease.
Słowa kluczowe: zespół antyfosfolipidowy, zapalenie okołożylne naczyń siatkówki, przeciwciała antyfosfolipidowe, przeciwciała antykardiolipinowe, antykoagulant toczniowy, potenciały wywołane, FLA, OCT, perymetria statyczna.
Keywords: antiphospholipid complex, periphlebitis of the retinal vessels, antiphospholipid antibodies, anticardiolipin antibodies, lupus anticoagulant, evoked potentials, FA, OCT, static perimetry.