Retinal Vasculitis as a Rare Presentation of Microscopic Polyangiitis

Area of Science:

• Rheumatology
• Ophthalmology
• Neurology

Background:

• Microscopic polyangiitis (MPA) is a rare autoimmune small-vessel vasculitis, typically associated with perinuclear antineutrophil cytoplasmic antibodies (p-ANCA).
• Clinical manifestations commonly involve fatigue, fever, weight loss, arthralgia, skin lesions, and kidney or lung involvement.
• Ocular manifestations are exceptionally rare in MPA.

Observation:

• A 60-year-old male presented with sudden left-hand weakness, fever, and transient vision loss (amaurosis fugax).
• He reported preceding fatigue and stocking-glove paresthesia.
• Ophthalmologic examination revealed mild temporal retinal vasculitis, confirmed by fluorescein angiography.

Findings:

• Laboratory results showed inflammatory anemia, elevated ESR, mild proteinuria, autoimmune hypothyroidism, and positive p-ANCA-myeloperoxidase (MPO) antibodies.
• Renal and nerve biopsies confirmed crescentic and small-vessel vasculitis, respectively.
• The patient tested positive for anti-nuclear antibodies (ANA) with a nuclear-dense pattern.

Implications:

• This case underscores retinal vasculitis as a rare, yet possible, ocular manifestation of microscopic polyangiitis.
• Prompt diagnosis and treatment with immunosuppressants like prednisolone and azathioprine led to clinical improvement.
• Highlights the importance of considering MPA in patients presenting with unexplained neurological and ocular symptoms, even without typical systemic involvement.