Bilateral occlusive retinal vasculitis associated with primary sclerosing cholangitis

Area of Science:

• Ophthalmology
• Gastroenterology
• Endocrinology

Background:

• Primary sclerosing cholangitis (PSC) is a rare, chronic cholestatic liver disease with poorly understood etiology.
• Ocular manifestations in PSC patients are uncommon, with limited literature on their association.
• Autoimmune phenomena are implicated in PSC, but direct links to specific ocular conditions remain unclear.

Observation:

• A 46-year-old male diagnosed with PSC presented with bilateral panuveitis and occlusive retinal vasculitis.
• The patient was a lifelong bodybuilder with a history of prolonged androgenic-anabolic steroid (AAS) use.
• Ocular symptoms emerged after cessation of AAS, despite normal autoimmune markers.

Findings:

• The clinical presentation suggests a potential link between PSC and AAS-induced immunosuppression leading to ocular autoimmune disease.
• Androgenic-anabolic steroids may have suppressed latent ocular autoimmune activity, with symptoms manifesting upon withdrawal.
• This case highlights the complex interplay between liver disease, steroid use, and autoimmune responses in the eye.

Implications:

• Further research is needed to elucidate the relationship between PSC, AAS use, and the development of occlusive panuveitis.
• Ophthalmologists and gastroenterologists should consider AAS history in PSC patients presenting with unexplained uveitis or retinal vasculitis.
• This case underscores the importance of a comprehensive patient history, including substance use, in diagnosing complex conditions.