Bilateral retinal vasculitis in a patient with lichen planus

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Abstract

ABSTRACT Lichen planus (LP) is an autoimmune, inflammatory disease of unknown etiology that commonly affects the skin and mucous membranes. Retinal vasculitis is a group of vision-threatening disorders, in which autoimmunity is thought to play a role in pathogenesis. We present the case of a patient who was diagnosed with retinal vasculitis and who was followed up for mucosal LP. LP has not been reported as a cause of retinal vasculitis in the literature. We believe that the retinal vasculitis in this case was related to LP because cellular immunity plays a role in the pathogenesis of both entities.

Translated abstract

RESUMO Líquen plano (LP) é uma doença auto-imune, inflamatória de etiologia desconhecida que normalmente afeta a pele e membranas mucosas. Vasculite retiniana engloba um grupo de doenças que ameaçam a visão em que a autoimunidade parece desempenhar um papel na sua patogênese. Apresentamos um caso que foi diagnosticado com vasculite da retina e que tinha sido acompanhado com LP de mucosa. LP não consta entre as causas de vasculite retiniana na literatura. Acreditamos que a vasculite da retina no nosso caso, foi relacionado com o LP considerando que a imunidade celular desempenha um papel na patogênese de ambas as entidades.

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Cutaneous and Mucosal Lichen Planus: A Comprehensive Review of Clinical Subtypes, Risk Factors, Diagnosis, and Prognosis

Farzam Gorouhi, Parastoo Davari, Nasim Fazel (2014)

Lichen planus (LP) is a chronic inflammatory disorder that most often affects middle-aged adults. LP can involve the skin or mucous membranes including the oral, vulvovaginal, esophageal, laryngeal, and conjunctival mucosa. It has different variants based on the morphology of the lesions and the site of involvement. The literature suggests that certain presentations of the disease such as esophageal or ophthalmological involvement are underdiagnosed. The burden of the disease is higher in some variants including hypertrophic LP and erosive oral LP, which may have a more chronic pattern. LP can significantly affect the quality of life of patients as well. Drugs or contact allergens can cause lichenoid reactions as the main differential diagnosis of LP. LP is a T-cell mediated immunologic disease but the responsible antigen remains unidentified. In this paper, we review the history, epidemiology, and clinical subtypes of LP. We also review the histopathologic aspects of the disease, differential diagnoses, immunopathogenesis, and the clinical and genetic correlations.

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A clinical approach to the diagnosis of retinal vasculitis.

A Sharkawy, K Tabbara, Carl P Herbort (2010)

Retinal vasculitis is a sight-threatening inflammatory eye condition that involves the retinal vessels. Detection of retinal vasculitis is made clinically, and is confirmed with the help of fundus fluorescein angiography. Active vascular disease is characterized by exudates around retinal vessels resulting in white sheathing or cuffing of the affected vessels. In this review, a practical approach to the diagnosis of retinal vasculitis is discussed based on ophthalmoscopic and fundus fluorescein angiographic findings.

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Primary retinal vasculitis. Systemic associations and diagnostic evaluation.

Robert Nussenblatt, David George, Scott Whitcup … (1996)

Inflammation of the retinal vasculature without an infectious etiology, systemic disease association, or concomitant ocular disease is termed primary retinal vasculitis, and can result in severe and permanent vision loss. Patients with primary retinal vasculitis usually are subjected to an extensive but unrewarding diagnostic evaluation. This study was undertaken to determine the value of such a diagnostic workup, and to determine whether systemic diseases develop in these patients during the course of their illness. The clinical records of 25 patients seen between 1984 and 1994 with the referring diagnosis of primary retinal vasculitis were reviewed retrospectively. Recorded data included patient age, sex, race, medical history, medications, visual acuity, extent of retinal disease, and the results of their diagnostic evaluations. On presentation, none of the patients had an underlying systemic disease attributable as the cause of their retinal vasculitis. Review of systems was suggestive of an underlying systemic disease in 1 of 25 patients. Diagnostic evaluation in this patient showed a positive antinuclear antibody value and a double-stranded DNA, suggestive of systemic lupus erythematosus. Subsequently, systemic lupus erythematosus was diagnosed based on the development of other diagnostic criteria. The review of systems was not suggestive of an underlying systemic disease in 24 of 25 patients. False-positive diagnostic test results were obtained in 5 (20.8%) of these 24 patients. No underlying systemic disease associated with the patients' retinal vasculitis subsequently developed in any of these five patients (mean follow-up, 4 years). Few diagnostic tests should be ordered in patients with retinal vasculitis in the absence of a medical history suggestive of underlying systemic disease.

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Author and article information

Contributors

Seyhan Dikci: Role: ND

Oğuzhan Genç: Role: ND

Turgut Yılmaz: Role: ND

Penpe Gül Fırat: Role: ND

Journal

Journal ID (publisher-id): abo

Title: Arquivos Brasileiros de Oftalmologia

Abbreviated Title: Arq. Bras. Oftalmol.

Publisher: Conselho Brasileiro de Oftalmologia (São Paulo, SP, Brazil )

ISSN (Print): 0004-2749

ISSN (Electronic): 1678-2925

Publication date (Print and electronic): December 2016

Volume: 79

Issue: 6

Pages: 402-403

Affiliations

[1] Malatya orgnameInönü University orgdiv1Department of Ophthalmology Turkey

Article

Publisher ID: S0004-27492016000600402

DOI: 10.5935/0004-2749.20160113

SO-VID: dab4a2d2-6b52-455c-ab4b-d43ff29ddfa5

License:

This work is licensed under a Creative Commons Attribution 4.0 International License.

History

Date received : 11 September 2015

Date accepted : 07 January 2016

Page count

Figures: 0, Tables: 0, Equations: 0, References: 6, Pages: 2

Product

SciELO Brazil

Keywords: Retina,Vasculite retiniana,Líquen plano,Angiofluoresceinografia,Retinal vasculitis,Lichen planus,Fluorescein angiography

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Keywords: Retina, Vasculite retiniana, Líquen plano, Angiofluoresceinografia, Retinal vasculitis, Lichen planus, Fluorescein angiography

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