Extraintestinal manifestations (EIM) of Inflammatory Bowel Disease may be the first clinical evidence of disease. Our purpose is to describe the case of a new-onset optic nevritis associated with a previously undiagnosed Ulcerative Colitis (UC).
Methods
Case-report
Results
A 20-year-old male patient presented to the Ophthalmology Department complaining of diminished vision. He had an ocular history of a recurrent alternating nongranulomatous anterior uveitis, which was under etiological investigation. His past medical history was relevant for a left paramedian pontine acute ischemic stroke, without an established etiology despite intensive evaluation and diagnostic testing. Family history was positive for Crohn and Celiac disease. His visual acuity was 0.6 (decimal scale) in both eyes. Biomicroscopy revealed recurrence of anterior uveitis in RE. Fundoscopy revealed left optic disc swelling with macular edema. Fluorescein angiography showed bilateral optic disc edema, more accentuated in LE, with peripapillary dye leakage. Optical coherence tomography revealed bilateral optic disc edema with secondary subfoveal detachment in LE and standard automated perimetry revealed a left blind spot enlargement. Although no other systemic symptoms or signs were found, further examination showed increased fecal calprotectin level and the patient underwent upper gastrointestinal endoscopy and colonoscopy, whose anatomopathological findings were highly suggestive of UC. 5-aminosalicylic acid therapy successfully improved both ophthalmological and gastrointestinal findings.
Conclusion
Although rare, optic nevritis is a potentially severe EIM of UC which may occur in otherwise asymptomatic young patients. A multidisciplinary cooperation is necessary for the management of these patients.
Conflict of interest
No
Authors 1
Last name
PINTO PROENÇA
Initials of first name(s)
R
Department
Ophthalmology, Centro Hospitalar e Universitário de Lisboa Central
City
Lisboa
Country
Portugal
Authors 2
Last name
MOTA
Initials of first name(s)
C
Department
Ophthalmology, Centro Hospitalar e Universitário de Lisboa Central
City
Lisboa
Country
Portugal
Authors 3
Last name
Cunha
Initials of first name(s)
B
Department
Ophthalmology, Centro Hospitalar e Universitário de Lisboa Central
City
Lisboa
Country
Portugal
Authors 4
Last name
Ludovico
Initials of first name(s)
I
Department
Ophthalmology, Centro Hospitalar e Universitário de Lisboa Central
City
Lisboa
Country
Portugal
Authors 5
Last name
Alves
Initials of first name(s)
N
Department
Ophthalmology, Centro Hospitalar e Universitário de Lisboa Central
City
Lisboa
Country
Portugal
Authors 6
Last name
Jorge
Initials of first name(s)
I
Department
Ophthalmology, Hospital de Cascais, Dr. José de Almeida
City
Lisboa
Country
Portugal
Authors 7
Last name
Guedes
Initials of first name(s)
M
Department
Ophthalmology, Centro Hospitalar de Lisboa Ocidental
City
Lisboa
Country
Portugal
Authors 8
Last name
LOPES
Initials of first name(s)
E
Department
Ophthalmology, Centro Hospitalar e Universitário de Lisboa Central
City
Lisboa
Country
Portugal
Authors 9
Last name
Pires
Initials of first name(s)
G
Department
Ophthalmology, Centro Hospitalar e Universitário de Lisboa Central
City
Lisboa
Country
Portugal
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