RT Journal Article
SR Electronic
T1 Optic neuropathy, renal failure and pulmonary sarcoidosis in a 50-year-old man: where is the link?
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr0520091879
DO 10.1136/bcr.05.2009.1879
VO 2009
A1 Laurence Buisseret
A1 Nacima Kisma
A1 Annick Massart
A1 Frédéric D Debelle
A1 Elie Cogan
A1 Monique Cordonnier
YR 2009
UL http://casereports.bmj.com/content/2009/bcr.05.2009.1879.abstract
AB 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.