Inflammatory optic neuropathy in granulomatosis with polyangiitis can mimick isolated idiopathic optic neuritis

Clément, Manon; Néel, A.; Toulgoat, F.; Weber, Michel; Godmer, Pascal; Hutin, P.; Hamidou, M.; Lebranchu, Pierre

doi:10.1177/1120672119889008

Cited by 10 publications

(11 citation statements)

References 16 publications

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“…The optic nerve may be affected in several ways. Optic neuritis, as papillitis or retrobulbar neuritis and perineuritis, ischemic optic neuropathy, and optic nerve compression by granuloma have been described, with or without signs of orbital involvement [46][47][48][49]. Optic nerve ischemia is a result of focal vasculitis of small arteries, arterioles and small veins, vascular thrombosis and hemorrhage, granulomatous inflammation, or may be a sequela of chronic inflammation.…”

Section: Granulomatosis With Polyangiitis or Wegener's Granulomatosismentioning

confidence: 99%

Removed: Atypical Optic Neuritis

Zoric¹,

Čolak²

2023

Optic Nerve - New Diagnostic and Therapeutic Approaches [Cancelled Title]

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Optic neuritis (ON) is defined as inflammatory optic neuropathy. In its initial clinical appearance, ON can have unilateral or bilateral manifestation and anterior (papillitis) or retrobulbar localizations. Traditionally, they are divided into typical and atypical ON. In the western hemisphere, most optic nerve inflammations are associated with multiple sclerosis, in their typical form. However, ON can be associated with a series of disorders of unknown or known origin. Atypical ON has a somewhat different clinical picture from typical and encompasses neuromyelitis optica spectrum disease (NMOSD), idiopathic recurrent neuroretinitis (NR), chronic relapsing inflammatory optic neuritis (CRION), ON within systemic autoimmune diseases, and neuritis during or after infectious diseases or vaccination. Their cause should be meticulously worked up, because of the therapeutic and prognostic challenges that they present.

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Section: Granulomatosis With Polyangiitis or Wegener's Granulomatosismentioning

confidence: 99%

Removed: Atypical Optic Neuritis

Zoric¹,

Čolak²

2023

Optic Nerve - New Diagnostic and Therapeutic Approaches [Cancelled Title]

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“…The following mechanisms of optic nerve damage have been hypothesized: vasculitic infarction [ 26 , 27 ], nonvasculitic optic nerve inflammation, or spread of inflammation from the adjacent sinuses [ 28 , 29 ]. Moreover, some GPA-related isolated neuropathy cases were suspected to be caused by granulomatous optic neuropathy located within the optic nerve sheath [ 5 ]. As MRI showed mild enhancement of the optic nerve and good visual recovery after treatment in the current case, we considered spread of inflammation and compression due to thickened dura by HP were the main cause.…”

Section: Discussionmentioning

confidence: 99%

“…However, other causes of optic neuropathy, such as immunosuppressive drugs, radiation, infections, and inflammation, need to be ruled out [ 3 ]. Antineutrophil cytoplasmic antibody-associated vasculitis (ANCA-associated vasculitis) is characterized by inflammation of small to medium blood vessels, [ 4 ], and granulomatosis with polyangiitis (GPA), a subtype of ANCA-associated vasculitis, is one of the causes of inflammatory optic neuropathy [ 5 ]. Moreover, antithyroid drugs [propylthiouracil and methimazole (MMI)] are the most frequent causes of drug-induced ANCA-associated vasculitis [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Optic neuropathy secondary to granulomatosis with polyangiitis in a patient with Graves’ disease: a case report

et al. 2021

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Background Dysthyroid optic neuropathy is the most commonly suspected diagnosis of optic neuropathy in Graves’ patients; however, other causes need to be ruled out. We present a unique case of optic neuropathy secondary to hypertrophic pachymeningitis with antineutrophil cytoplasmic antibody-associated vasculitis, which was suspected to be antithyroid drug related. Case presentation A 79-year-old Japanese male presented with acute visual loss in the left eye. He had a 24-year history of Graves’ disease and was taking methimazole. Best-corrected visual acuity was 0.8 in the right eye and light perception in the left eye, and relative afferent pupillary defect in the left eye was seen. Ocular movement was normal, and there were no findings explaining visual loss in intermediate optic media and fundus in the left eye. Contrast-enhanced magnetic resonance imaging demonstrated thickened dura mater. Tests for myeloperoxidase-antineutrophil cytoplasmic antibody, proteinuria, and hematuria were positive; pulmonary nodule lesions and a blood clot in the left lower leg were also found. After excluding the presence of diseases that could lead to hypertrophic pachymeningitis, we diagnosed optic neuropathy due to hypertrophic pachymeningitis with granulomatosis with polyangiitis—a subtype of antineutrophil cytoplasmic antibody-associated vasculitis. Since he had history of using methimazole, antineutrophil cytoplasmic antibody-associated vasculitis was considered as drug related. We started high-dosage steroid pulse therapy followed by 1 mg/kg body weight daily of oral prednisolone, and subsequently tapered. Methimazole was stopped. Best-corrected visual acuity recovered to 0.9, 2 weeks after starting treatment. Though myeloperoxidase-antineutrophil cytoplasmic antibody remained negative, the symptom relapsed 6 months after treatment initiation. We gave a second high-dose steroid pulse therapy followed by prednisolone tapered together with methotrexate. Remission remained, and using 4 mg/week methotrexate without prednisolone, myeloperoxidase-antineutrophil cytoplasmic antibody was kept within the normal limit until now, 4 years after onset. Conclusion We present a case of optic neuropathy with hypertrophic pachymeningitis related to antineutrophil cytoplasmic antibody-associated vasculitis, which was suspected to be drug related. The patient had good visual recovery after quitting the drug and receiving immunosuppressive therapy with systemic steroids. Hypertrophic pachymeningitis with antineutrophil cytoplasmic antibody-associated vasculitis related to antithyroid drugs should be considered as a differential diagnosis for optic neuropathy in Graves’ patients in whom optic nerve compression is not obvious.

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“…Diagnosis requires anti-PR3 or anti-myeloperoxydase antibodies associated with clinically defined granulomatous ear, nose, and throat involvement; this rare and severe condition may mimic CRION and requires sustained treatment. 56 ON associated with sarcoidosis has been typically considered to be corticosteroid-responsive, but often relapses after treatment withdrawal. 57,58 This diagnosis is suspected with angiotensin converting enzyme and lysozyme blood tests (but these are sometimes normal) and thoracic imaging: thoracic tomography assesses mediastinal lymphadenopathy; positron emission imaging assesses other lesions for biopsy.…”

Section: Secondary Optic Neuritismentioning

confidence: 99%

“…Few cases of ON associated with SLE, 51,52 sarcoïdosis, 95 GPA, 56 or Neuro-Behçet's disease 96 have been described in adolescents so clinician must keep in mind these differential diagnosis and apply the same diagnostic criteria as in adults described in the paragraph "secondary optic neuritis. "…”

Section: Pediatric Onmentioning

confidence: 99%

Optic neuritis classification in 2021

Ducloyer¹,

Marignier

Wiertlewski³

et al. 2021

European Journal of Ophthalmology

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Optic neuritis (ON) can be associated with inflammatory disease of the central nervous system or can be isolated, with or without relapse. It can also be associated with infectious or systemic disease. These multiple associations based on a variety of clinical, radiological, and biological criteria that have changed over time have led to overlapping phenotypes: a single ON case can be classified in several ways simultaneously or over time. As early, intensive treatment is often required, its diagnosis should be rapid and precise. In this review, we present the current state of knowledge about diagnostic criteria for ON aetiologies in adults and children, we discuss overlapping phenotypes, and we propose a homogeneous classification scheme. Even if distinctions between typical and atypical ON are relevant, their phenotypes are largely overlapping, and clinical criteria are neither sensitive enough, nor specific enough, to assure a diagnosis. For initial cases of ON, clinicians should perform contrast enhanced MRI of the brain and orbits, cerebral spinal fluid analysis, and biological analyses to exclude secondary infectious or inflammatory ON. Systematic screening for MOG-IgG and AQP4-IgG IgG is recommended in children but is still a matter of debate in adults. Early recognition of neuromyelitis optica spectrum disorder, MOG-IgG-associated disorder, and chronic relapsing idiopathic optic neuritis is required, as these diagnoses require therapies for relapse prevention that are different from those used to treat multiple sclerosis.

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Inflammatory optic neuropathy in granulomatosis with polyangiitis can mimick isolated idiopathic optic neuritis

Cited by 10 publications

References 16 publications

Removed: Atypical Optic Neuritis

Removed: Atypical Optic Neuritis

Optic neuropathy secondary to granulomatosis with polyangiitis in a patient with Graves’ disease: a case report

Optic neuritis classification in 2021

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