Article Text

Unusual presentation of more common disease/injury
Optic neuropathy, renal failure and pulmonary sarcoidosis in a 50-year-old man: where is the link?
  1. Laurence Buisseret1,
  2. Nacima Kisma2,
  3. Annick Massart3,
  4. Frédéric D Debelle4,
  5. Elie Cogan1,
  6. Monique Cordonnier2
  1. 1
    Erasme Hospital, Internal Medicine, Route de Lennik 808, Brussels, 1070, Belgium
  2. 2
    Erasme Hospital, Ophthalmology, Route de Lennik 808, Brussels, 1070, Belgium
  3. 3
    Erasme Hospital, Nephrology, Dialysis and Renal Transplantation, Route de Lennik 808, Brussels, 1070, Belgium
  4. 4
    RHMS Baudour, Nephrology Dialysis, Rue Louis Caty 136, Baudour, 7331, Belgium
  1. Frédéric D Debelle, fdebelle{at}ulb.ac.be

Summary

Eye disorders are frequently associated with renal diseases, mostly linked to underlying causes such as hypertension, diabetes or autoimmune diseases. Conversely, advanced uraemic states may also lead to progressive vision impairment. The present report concerns a 50-year-old patient who presented with a bilateral, painless, progressive vision loss, a moderate systemic inflammation and chronic renal failure due to hypertension nephrosclerosis. Steroids were given and haemodialysis was initiated, resulting in vision improvement. At 4 months later when the steroids were stopped, the patient developed dyspnoea, cough, fever and fatigue of unclear origin. A lung biopsy showed non-caseating granuloma consistent with pulmonary sarcoidosis. Re-challenge with steroids rapidly improved the respiratory disease. Ophthalmological examinations performed early and later in the course excluded anterior ischaemic optic neuropathy and ocular manifestations of sarcoidosis, leading to a diagnosis of uraemic optic neuropathy. This rare ophthalmological disorder should be promptly recognised since haemodialysis and steroid therapy are highly effective.

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Footnotes

  • Competing interests: None.

  • Patient consent: Patient/guardian consent was obtained for publication.

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