CASE REPORTS
Bilateral Central Retinal Vein Occlusion in a patient with Ulcerative Colitis and Antiphospholipid Antibody Syndrome Sameer Lapsia, Rina Meyer, Azin Abazari, Kathleen Usmani, and Grace Gathungu
P
ro-inflammatory conditions such as inflammatory bowel disease (IBD) may lead to a prothrombotic state. Coagulation abnormalities in ulcerative colitis (UC) or Crohn’s disease (CD) are associated with increased concentrations of factor V, factor VIII, and fibrinogen or deficiency of protein C/S or antithrombin III. However, there are myriad patients with IBD that have had arterial and/or venous thrombosis formation despite normal coagulation factors (1). Vascular complications of UC and CD include deep vein thrombosis, cerebral vein thrombosis, and as well as central retinal vein occlusion (CRVO). While the retinal vein is an unusual site for thrombosis, there have been a few case reports describing unilateral CRVO in patients with IBD. Here we describe a unique case of a UC patient with visual complaints found to have bilateral central retinal vein occlusion. Further workup led to an additional diagnosis of antiphospholipid syndrome (APS). The importance of prompt recognition and treatment to prevent visual loss is further discussed.
CASE REPORT A 19 year old non-smoker with known UC presented with 2 week history of blurry vision in his right eye. His past ophthalmic history was unremarkable. The patient was diagnosed as having UC 2 years prior and at current presentation he had moderate-severe disease activity consisting of abdominal pain, diarrhea, and fatigue. He also developed severe anemia requiring multiple transfusions. His medications included prednisone daily, methotrexate weekly, and infliximab every 8 weeks. He was referred to an ophthalmologist where fundoscopic examination revealed an afferent pupillary defect (APD), significant disc swelling, cotton wool spots, macular edema, and retinal hemorrhages in all four quadrants consistent with ischemic central retinal vein occlusion in his right eye (Fig. 1). Left eye examination revealed mild disc edema and pre-retinal hemorrhages seen with non-ischemic CRVO. His visual acuity was 3/200 in his right eye and 20/20 in his left eye. Magnetic resonance imaging/magnetic resonance venography of the brain/orbits was normal, with no evidence of other thrombi. Although the patient and his family did not have a history of clotting disorders or thrombosis, he was subsequently evaluated for various hypercoagulable etiologies. Elevated b2-glycoprotein immunoglobulin G (IgG) antibody level of 50 SGU (Negative
Bilateral Central Retinal Vein Occlusion in a patient with Ulcerative Colitis and Antiphospholipid Antibody Syndrome Sameer Lapsia, Rina Meyer, Azin Abazari, Kathleen Usmani, and Grace Gathungu
P
ro-inflammatory conditions such as inflammatory bowel disease (IBD) may lead to a prothrombotic state. Coagulation abnormalities in ulcerative colitis (UC) or Crohn’s disease (CD) are associated with increased concentrations of factor V, factor VIII, and fibrinogen or deficiency of protein C/S or antithrombin III. However, there are myriad patients with IBD that have had arterial and/or venous thrombosis formation despite normal coagulation factors (1). Vascular complications of UC and CD include deep vein thrombosis, cerebral vein thrombosis, and as well as central retinal vein occlusion (CRVO). While the retinal vein is an unusual site for thrombosis, there have been a few case reports describing unilateral CRVO in patients with IBD. Here we describe a unique case of a UC patient with visual complaints found to have bilateral central retinal vein occlusion. Further workup led to an additional diagnosis of antiphospholipid syndrome (APS). The importance of prompt recognition and treatment to prevent visual loss is further discussed.
CASE REPORT A 19 year old non-smoker with known UC presented with 2 week history of blurry vision in his right eye. His past ophthalmic history was unremarkable. The patient was diagnosed as having UC 2 years prior and at current presentation he had moderate-severe disease activity consisting of abdominal pain, diarrhea, and fatigue. He also developed severe anemia requiring multiple transfusions. His medications included prednisone daily, methotrexate weekly, and infliximab every 8 weeks. He was referred to an ophthalmologist where fundoscopic examination revealed an afferent pupillary defect (APD), significant disc swelling, cotton wool spots, macular edema, and retinal hemorrhages in all four quadrants consistent with ischemic central retinal vein occlusion in his right eye (Fig. 1). Left eye examination revealed mild disc edema and pre-retinal hemorrhages seen with non-ischemic CRVO. His visual acuity was 3/200 in his right eye and 20/20 in his left eye. Magnetic resonance imaging/magnetic resonance venography of the brain/orbits was normal, with no evidence of other thrombi. Although the patient and his family did not have a history of clotting disorders or thrombosis, he was subsequently evaluated for various hypercoagulable etiologies. Elevated b2-glycoprotein immunoglobulin G (IgG) antibody level of 50 SGU (Negative
