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  • August 10, 2022
  • Author: Sei Moon

Case: Enlarged adrenals and white lesions in the eye (Case Club 1-8; 29 Jun, 2022)

Presenters: Shaikha Aljneibi & Aniruddha Agarwal, Cleveland Clinic Abu Dhabi

Case Summary:

A 33-year-old male patient was referred to our Eye clinic with complaints of eye pain in the right eye (OD) for the past 10 days. This was associated with blurring of vision and headache. The past medical history was significant for congenital adrenal hyperplasia which was being treated with 5 mg oral prednisolone daily and 0.1 mg fludrocortisone once a day. The initial assessment in our clinic revealed a best-corrected visual acuity of 20/60 in OD and 20/25 in the left eye (OS). The intraocular pressure (IOP) was 14 mm Hg in both eyes. The pupils were equal in size and reacting normally. Anterior segment of OD revealed 4+ cells and flare, and dilated fundus examination revealed 2+ vitreous cells and confluent, 360-degree necrotic white lesions with arteriolar sheathing and hemorrhages. Examination of OS was unremarkable. The clinical examination was consistent with the diagnosis of acute retinal necrosis (ARN) in OD. Notably, the optical coherence tomography (OCT) scan revealed “cavernous pattern” of retinal necrosis with destruction of retinal layers. The patient was admitted and received intravenous acyclovir 10mg/kg every 8 hours for 10 days along with intravitreal foscarnet (2 doses). Three weeks after initial presentation, the patient developed a rhegmatogenous retinal detachment with a large sieve-like retinal break infero-temporally. He underwent OD pars plana vitrectomy with internal limiting membrane peeling, and silicone oil tamponade. Postoperatively, the patient had an attached retina with healed retinitis lesions, visual acuity of 20/150, and OCT did not show any epiretinal membrane or macular edema.

Key Images:

Fundus photograph of the patient showing confluent areas of peripheral retinal necrosis, retinal arteriolitis and hemorrhages.

 

Optical coherence tomography (OCT) shows presence of cavernous pattern of retinal necrosis.

 

Postoperative fundus photograph reveals attached retina with silicone oil filled, and laser marks in the temporal area.
Watch this Case presentation and discussion here.
Presented during EURETINA Case Club – Series 1, Episode 8 with Bahram Bodaghi and Carlos Pavesio (29 Jun, 2022) – RECORDING AVAILABLE TO MEMBERS ONLY.

 

Browse all cases from this Case Club

Enlarged adrenals and lesions in the eye – Aniruddha Agarwal, Shaikha Aljneibi

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I survived cancer, now I can’t see – Sofia Androudi, Katerina Lazari, Konstantina Riri

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Branch retinal artery occlusion in a young healthy adult – Moncef Khairallah, Imen Ksiaa

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A mysterious bilateral stromal choroiditis in a young male patient – Alfredo Adan, Lucia Miguel

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Those retinal infiltrates – what could they be? Carlos Pavesio, Ilaria Testi

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When the vitreous gives you all – Bahram Bodaghi, Aurore Chauvin

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