Relapsing polychondritis presenting as bilateral acute angle closure: an unusual diagnostic challenge

Area of Science:

• Ophthalmology
• Rheumatology
• Medical Case Reports

Background:

• Relapsing polychondritis (RP) is a rare systemic autoimmune disease affecting cartilage.
• Ocular manifestations of RP can be diverse and challenging to diagnose.
• Early identification of RP is crucial for effective management and preventing complications.

Purpose of the Study:

• To report a rare case of relapsing polychondritis presenting initially as bilateral angle-closure glaucoma.
• To highlight the diagnostic challenges posed by late-appearing classical features of RP.
• To emphasize the importance of considering RP in unexplained ocular inflammation.

Main Methods:

• A 54-year-old male presented with bilateral eye pain, redness, and elevated intraocular pressure.
• Diagnostic workup included ultrasound biomicroscopy, infectious/autoimmune evaluations, and indocyanine green angiography.
• Modified Michet's criteria were used for diagnosis after the late development of auricular chondritis.

Main Results:

• The patient experienced recurrent bilateral angle closure and anterior uveitis.
• Classical signs of RP, such as perichondritis, manifested late.
• Clinical improvement was observed with high-dose corticosteroids and azathioprine.

Conclusions:

• This case expands the clinical spectrum of relapsing polychondritis.
• Considering RP in patients with unexplained ocular inflammation and systemic symptoms is vital.
• Early recognition and a multidisciplinary approach are essential for managing RP.