Toxic retrobulbar neuritis due to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-based chronic sinusitis in the left sphenoid sinus: a case report.
Blindness
Case report
Inflammation mediators
Neuritis
Optic
Sinusitis
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
04 Aug 2023
04 Aug 2023
Historique:
received:
30
05
2022
accepted:
26
06
2023
medline:
7
8
2023
pubmed:
4
8
2023
entrez:
3
8
2023
Statut:
epublish
Résumé
Abrupt visual impairment constitutes a medical urgency, necessitating an interdisciplinary diagnostic and therapeutic approach owing to the broad spectrum of potential etiologies, thereby engaging numerous medical specialties. A 21-year-old Mixed White and Asian female patient, with medical history of nonsteroidal antiinflammatory drug-exacerbated respiratory disease necessitating previous sinus surgery, reported sudden monocular vision loss. Unremarkable ophthalmological examination of the fellow eye and hematological parameters, save for a slight elevation in lymphocytes and eosinophils, were observed. Imaging studies indicated recurrence of bilateral chronic rhinosinusitis with nasal polyps and a mucocele in the left sphenoid sinus, accompanied by bony structural deficits. Emergency revision sinus surgery, guided by navigation, was promptly performed. The patient received treatment with methylprednisolone, ceftriaxone, cyanocobalamin, pyridoxine, thiamine, and acetylsalicylic acid. During the hospital stay, she developed steroid-induced glaucoma, which was subsequently managed successfully. Negative microbiological swabs, along with pathohistological evidence of increased tissue eosinophilia and the patient's clinical history, led to the diagnosis of toxic retrobulbar neuritis secondary to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-associated chronic rhinosinusitis of the left sphenoid sinus. In cases of acute unilateral vision loss, optic neuritis is a highly probable differential diagnosis and may be induced by pathologies of the paranasal sinuses. Nonsteroidal antiinflammatory drug-exacerbated respiratory disease, a subtype of chronic rhinosinusitis, is associated with type 2 inflammation, which is increasingly recognized for its role in the pathogenesis of bronchial asthma, eosinophilic esophagitis, and atopic eczema. Clinicians should consider chronic rhinosinusitis as a potential differential diagnosis in unilateral visual loss and be cognizant of the rising significance of type 2 inflammations, which are relevant to a variety of diseases.
Sections du résumé
BACKGROUND
BACKGROUND
Abrupt visual impairment constitutes a medical urgency, necessitating an interdisciplinary diagnostic and therapeutic approach owing to the broad spectrum of potential etiologies, thereby engaging numerous medical specialties.
CASE PRESENTATION
METHODS
A 21-year-old Mixed White and Asian female patient, with medical history of nonsteroidal antiinflammatory drug-exacerbated respiratory disease necessitating previous sinus surgery, reported sudden monocular vision loss. Unremarkable ophthalmological examination of the fellow eye and hematological parameters, save for a slight elevation in lymphocytes and eosinophils, were observed. Imaging studies indicated recurrence of bilateral chronic rhinosinusitis with nasal polyps and a mucocele in the left sphenoid sinus, accompanied by bony structural deficits. Emergency revision sinus surgery, guided by navigation, was promptly performed. The patient received treatment with methylprednisolone, ceftriaxone, cyanocobalamin, pyridoxine, thiamine, and acetylsalicylic acid. During the hospital stay, she developed steroid-induced glaucoma, which was subsequently managed successfully. Negative microbiological swabs, along with pathohistological evidence of increased tissue eosinophilia and the patient's clinical history, led to the diagnosis of toxic retrobulbar neuritis secondary to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-associated chronic rhinosinusitis of the left sphenoid sinus.
CONCLUSIONS
CONCLUSIONS
In cases of acute unilateral vision loss, optic neuritis is a highly probable differential diagnosis and may be induced by pathologies of the paranasal sinuses. Nonsteroidal antiinflammatory drug-exacerbated respiratory disease, a subtype of chronic rhinosinusitis, is associated with type 2 inflammation, which is increasingly recognized for its role in the pathogenesis of bronchial asthma, eosinophilic esophagitis, and atopic eczema. Clinicians should consider chronic rhinosinusitis as a potential differential diagnosis in unilateral visual loss and be cognizant of the rising significance of type 2 inflammations, which are relevant to a variety of diseases.
Identifiants
pubmed: 37537663
doi: 10.1186/s13256-023-04060-3
pii: 10.1186/s13256-023-04060-3
pmc: PMC10401847
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
331Informations de copyright
© 2023. The Author(s).
Références
Int Forum Allergy Rhinol. 2020 Apr;10(4):450-464
pubmed: 31951112
Am J Rhinol Allergy. 2016 Mar-Apr;30(2):134-9
pubmed: 26980394
Rhinol Suppl. 2012 Mar;23:3 p preceding table of contents, 1-298
pubmed: 22764607
Rhinology. 2020 Feb 20;58(Suppl S29):1-464
pubmed: 32077450
J Allergy Clin Immunol. 2015 Mar;135(3):676-81.e1
pubmed: 25282015
Allergy. 2019 Dec;74(12):2291-2292
pubmed: 31067351
J Allergy Clin Immunol Pract. 2017 Jul - Aug;5(4):1061-1070.e3
pubmed: 28286156
J Allergy Clin Immunol. 2017 Mar;139(3):764-766
pubmed: 27771324
J Trauma. 1998 Dec;45(6):1088-93
pubmed: 9867054
Auris Nasus Larynx. 2019 Aug;46(4):520-525
pubmed: 30528105
Lancet. 2019 Nov 2;394(10209):1638-1650
pubmed: 31543428
Am J Rhinol Allergy. 2021 May;35(3):399-407
pubmed: 32967430
Drugs. 2017 Jul;77(10):1115-1121
pubmed: 28547386
Surv Ophthalmol. 2019 Nov - Dec;64(6):770-779
pubmed: 31229520
BMJ Case Rep. 2019 Apr 30;12(4):
pubmed: 31040145