ABSTRACT
IMPORTANCE: Patients with neuromyelitis optica who have aquaporin-4 antibodies are being identified and receiving immunosuppressant treatment earlier and more aggressively as a result of increasing awareness of the importance of preventing relapses responsible for the high morbidity and mortality associated with the disease. To our knowledge, opportunistic retinal infection in patients with aquaporin-4 antibodies who are receiving immunosuppressants has not been reported to date. OBSERVATIONS: We describe 2 patients with aquaporin-4 antibodies who were receiving conventional doses of first-line immunosuppressive therapy. Both patients presented with vision loss that was initially thought to be optic neuritis attacks. The subsequent diagnoses were ocular toxoplasmosis and cytomegalovirus retinitis. CONCLUSIONS AND RELEVANCE: Retinal opportunistic infections can occur in patients with aquaporin-4 antibodies who are receiving relatively low levels of immunosuppression, may mimic optic neuritis, and are a potentially reversible cause of vision loss when treated promptly.
Subject(s)
Aquaporin 4/metabolism , Neuromyelitis Optica/immunology , Opportunistic Infections/etiology , Optic Neuritis/immunology , Retina/immunology , Aged , Antibodies/adverse effects , Antibodies/therapeutic use , Aquaporin 4/immunology , Female , Humans , Immunosuppressive Agents/therapeutic use , Middle Aged , Neuromyelitis Optica/diagnosis , Neuromyelitis Optica/drug therapy , Opportunistic Infections/immunology , Optic Neuritis/complicationsABSTRACT
This study illustrates the case of a middle-aged woman who presented with sepsis and purpura fulminans, found to be due to Streptococcus pneumoniae infection. She later developed blindness from a dramatic ocular inflammatory response provoked by pneumococcal antigens.
