Atypical venous vasculitis as a complication of venous thrombosis

Abstract

Purpose: To asses the importance of multimodality imaging in successive examinations of patients with retinal branch vein occlusion in order to evaluate possible unexpected complications. Methods: We present a descriptive study (case report). We have performed a multimodal imaging study of a patient with an inferior temporal branch vein thrombosis. The best corrected visual acuity (BCVA) is taken in a patient who received 5 intravitreal injections of Ranibizumab. Posteriorly the patient presented with a decrease in visual acuity and the angiographic study showed a venous vasculitis involving the inferior temporal branch retinal vein, resembling frosted branch angiitis. Optical coherence tomography (OCT) showed inflammatory cystic macular edema with neurosensory detachment. To perform angiography and OCT, we use the Heidelberg Spectralis. Results: Serial evaluation with OCT allowed the observation of a cystic macular edema with neurosensory detachment that was treated with intravitreal Dexamethasone implantation achieving a BCVA of 0.3 to a BCVA of 0.7 after 2 months. Angiography showed a perivenular infiltration that reminded us of frosted branch angiitis. General laboratory tests and serology for cytomegalovirus and Epstein–Barr virus were requested, and the patient was referred to the internal medicine department to rule out systemic diseases. Conclusions: Serial multimodality imaging is very useful in the follow‐up of patients with venous occlusions. It allows us to observe atypical complications such as vasculitis found in the context of a patient who suffered a venous branch occlusion. Vasculitis can be found in the context of an ocular disease or associated with diseases such as Bechet's disease, Sarcoidosis, Multiple Sclerosis, Lupus, Polyarteritis nodosa, Sjogren's disease, Relapsing polychondritis, Antiphospholipid antibodies, Syphilis, Whipple's disease, Cytomegalovirus infection, leukaemia or lymphomas. Despite the growing popularity of OCT, we cannot ignore the importance of fluorescein angiography for the follow‐up of these cases.