Stellar Neuroretinitis as Presenting Sign of Behcet's Disease

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Austin Ophthalmol. 2021; 5(1): 1018.

Stellar Neuroretinitis as Presenting Sign of Behcet’s Disease

Jouidi W*, Moutarajji KL, Abdellah E and Berraho A

Department of Ophthalmology B, Mohammed V University, Morocco

*Corresponding author: Wafae Jouidi, Department of Ophthalmology B, Mohammed V University, Avicenne’s CHU of Rabat, Rabat, Morocco

Received: December 07, 2020; Accepted: January 12, 2021; Published: January 19, 2021

Observation

A 40-year-old One-eyed patient (right eye) acuity history of post-traumatic burst in his left eye at the age of 6 years. Consult for a decrease of vision on his right eye that has progressed for 3 weeks. Ophthalmic examination found visual acuity: 2/10 P10 in the right eye, the left eye presents enophthalmos with an opacified cornea; the anterior segment was normal in the right eye, fundus examination shows hyalitis graded 1+, papillary edema, peripapillary hemorrhages and stellar macular exudates, cottony nodules, copper arteries with vascular sheathing of the superior temporal branch and areas of retinal ischemia (Figure 1). The inflammatory and serological assessment is negative. Fluorescein retinal angiography shows papillary diffusion of fluorescein and vasculitis (Figure 2). We find serous retinal detachment on OCT (Figure 3). The general examination found bipolar aphthosis. The diagnosis of Behçet’s disease is retained. Treatment with immunosuppressants allowed the regression of papillary edema with persistence of some macular exudates and great improvingin visual acuity.

Figure 1: Fundus (Right eye) shows: Left: Neuroretinitis. Right: Occlusive vasculitis.

    

    
    

    

    Figure 1: Fundus (Right eye) shows: Left: Neuroretinitis. Right: Occlusive vasculitis.

Figure 2: Retinal angiography with fluorescein in late stages: On the left: papillary diffusion. On the left Right: vasculitis with vascular occlusion.

    

    
    

    

    Figure 2: Retinal angiography with fluorescein in late stages: On the left: papillary diffusion. On the left Right: vasculitis with vascular occlusion.

Figure 3: Optical Coherence Tomography (OCT): macular exudates especially at the level of the outer plexiform layer, serous retinal detachment.

    

    
    

    

    Figure 3: Optical Coherence Tomography (OCT): macular exudates
especially at the level of the outer plexiform layer, serous retinal detachment.

Discussion

Neuroretinitis can be due to several diseases; infectious diseases being the most frequent in young subjects [1,2]. More rarely, the inflammatory origin especially Behcet’s disease can produce neuroretinitis which is more frequently accompanied by a vitreous reaction [2,3]. Behcet’s disease is an idiopathic systemic inflammatory disease characterized by intraocular inflammation, oral and genital ulcers, skin lesions and many other visceral damage [4]. Ocular involvement is characterized by anterior hypopionic uveitis, posterior involvement being rarer, especially if it is isolated, which is the case in our patient [5,6]. OCT is used to check for posterior segment edema and/or Serious Retinal Detachment. Retinal angiography has a threefold benefit: confirming papillary edema, directing towards its ischemic or inflammatory aetiology and looking for vasculitis. The treatment of Behcet’s disease is controversial between corticosteroid therapy and immunosuppressants. The prognosis depends on the speed and precocity of the treatment, making collaboration between ophthalmologists and internists particularly important [7].

References

  1. Leavitt JA, Pruthi S, Morgenstern BZ. Hypertensive retinopathy mimicking neuro retinitis in a twelve-year-old girl. Surv Ophthalmol. 1997; 41: 477-480.
  2. Guyomard JL, Jacob H, Roche O, PierreKahn V, Charlin JF. Presentation d’un cas atypique de rétinopathie hypertensive maligne chez une fi llette. J Fr Ophtalmol. 2004; 27: 57-62.
  3. Esteve C, Achibet AM, Junot F, Ghassemi A, Rousseau B. A propos d’un cas de neuroretinite aigue de Leber. J Fr Ophtalmol. 2000; 23: 794-796.
  4. Shimizu T. Behcet’s syndrome-Lists of clinical and epidemical statistics. Nihon Rinsho. 1974; 32: 2093-2102.
  5. Michelson JB, Chisari FV. Behcet’s disease. Surv Ophthalmol. 1982; 26: 190- 203.
  6. Atmaca LS. Fundus changes associated with Behcet’s disease. Graefes Arch Clin Exp Ophthalmol. 1989; 227: 340-344.
  7. Alami A, Kriet M, Reda K, Laktaoui A, Oubaaz A. Behcet oculaire [Ocular Behçet]. Pan Afr Med J. 2017; 26: 237.

Citation:Jouidi W, Moutarajji KL, Abdellah E and Berraho A. Stellar Neuroretinitis as Presenting Sign of Behcet’s Disease. Austin Ophthalmol. 2021; 5(1): 1018.