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Optic neuropathy associated with periostitis in relapsing polychondritis
Parima Hirunwiwatkul1, Jonathan D Trobe
1Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan 48109, USA.
Summary
Optic neuropathy, a rare relapsing polychondritis (RPC) complication, can stem from periostitis in the eye socket. Early recognition of this imaging finding is crucial for managing this potentially life-threatening systemic condition.
Area of Science:
- Ophthalmology
- Rheumatology
- Neurology
Background:
- Relapsing polychondritis (RPC) is a rare systemic autoimmune disease targeting cartilage.
- Optic neuropathy is an uncommon but serious manifestation of RPC.
Observation:
- A case of recurrent, corticosteroid-responsive optic neuropathy is presented.
- Standard MRI revealed no direct optic nerve or orbital abnormalities.
- Distinctive findings included periosteal thickening and enhancement in the apical orbit and intracranial space, indicative of periostitis.
Findings:
- Periostitis, a manifestation of systemic vasculitis or autoimmune reaction, is proposed as the cause of optic neuropathy.
- The mechanism likely involves compression or inflammation of the optic nerve due to periostitis.
- This contrasts with previously attributed causes like ischemia or direct optic nerve inflammation.
Implications:
- Recognizing periostitis on imaging is critical for diagnosing RPC-associated optic neuropathy.
- This subtle imaging clue aids in identifying a potentially life-threatening systemic condition.
- Prompt management based on this diagnosis can improve patient outcomes.
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