Fatal posterior ischemic optic neuropathy.

OBJECTIVE: We would like to describe a case report of posterior ischemic optic neuropathy (PION) misdiagnosed as arteritic PION with presumed GCA which leads to missing the correct diagnosis with fatal outcome. METHODS: The clinical course of a single patient will be described including presentation, testing,diagnosis and treatment. RESULTS: An 82-year-old male patient presented with headache and temporal tenderness and mildly elevated ESR and was treated with steroids for presumed diagnosis of GCA. He developed progressive visual loss to NLP in the left eye while on steroids. MRI Brain and orbit showed enhanced mass at orbital apex misdiagnosed as incidental meningioma. Endoscopic biopsy was done and the pathology exam showed aspergillosis. The patient later died after he developed aspergillosis fungal meningitis with subsequent multiple brain infarcts despite appropriate antifungal treatment. CONCLUSION: Over-diagnosis of Giant cell arteritis and unwise use of steroids in elderly without appropriate work-ups can lead to unfavorable outcomes including a delay in diagnosis and an exacerbation of occult fungal infection that would manifest weeks later with a fatal outcome.

Anterior ischemic optic neuropathy associated with rickettsia conorii infection.

A 43-year-old man with fever, headache, and skin rash developed unilateral acute anterior ischemic optic neuropathy. The indirect immunofluorescence test was positive for Rickettsia conorii. Although retinal lesions have been described in Rickettsia conorii infection, this is the first reported case of ischemic optic neuropathy. This infection should be considered in a patient with nonarteritic anterior ischemic optic neuropathy with high fever or skin rash who inhabits or travels from an endemic area.

Chlamydia in anterior ischemic optic neuropathy.

There is an increasing body of evidence linking the common respiratory human pathogen Chlamydia pneumoniae with atherosclerosis and other vascular disorders. Our research was designed to investigate the association of this organism with anterior ischemic optic neuropathy (AION), representing an acute ischemic disorder of the optic nerve head. Sera were examined of 14 consecutive patients with AION and of 14 age- and sex-matched control subjects with noncardiovascular, nonpulmonary disorders. Antibodies against chlamydial lipopolysaccharide (LPS) and outer membrane proteins of C. pneumoniae were determined by ELISA. Further, nucleic acid amplification tests were done in order to detect C. pneumoniae-specific nucleotide sequences. Four patients (29%) were IgA positive, 11 (79%) were IgG positive and 1 (7%) was IgM positive for chlamydial LPS antibodies. In the control group, 36, 79 and 7% were IgA, IgG and IgM positive and showed no significant difference. IgA, IgG and IgM antibodies to C. pneumoniae were found in 43, 79 and 0% and did not differ from matched controls. By the nucleic acid amplification test, specific C. pneumo niae sequences were neither detected in the AION patients nor in the control group. These data do not support the association of AION with previous C. pneumoniae infection. However, it remains unclear whether Chlamydia actually initiates atherosclerotic injury, facilitates its progression or plays another role in other vascular disorders.

Chlamydia pneumoniae seropositivity and the risk of nonarteritic ischemic optic neuropathy.

OBJECTIVE: To determine whether IgG antibodies to Chlamydia pneumoniae are associated with nonarteritic ischemic optic neuropathy (NAION). DESIGN: Retrospective case-control study. PARTICIPANTS: The study cohort consisted of 71 consecutive patients with NAION and 71 controls matched for age and gender. MAIN OUTCOME MEASURES: Serum immunoglobulin G (IgG) antibody titers to Chlamydia pneumoniae. RESULTS: Patients with NAION had significantly higher IgG antibody titers to C. pneumoniae compared with control subjects (IgG titer > or =1:128: 29 patients versus 15 controls, P = 0.017). The odds ratio for patients with an IgG titer > or =1:128 was 2.56 (95% confidence interval [CI], 1.2-5.5). Adjustment for arterial hypertension, diabetes mellitus, and myocardial infarction resulted in an odds ratio of 3.48 (95% CI, 1.3-9.6). CONCLUSIONS: Our results suggest that elevated titers of IgG antibodies to C. pneumoniae are associated with NAION.