Publicação
Caso clínico : neurosarcoidose com envolvimento neuroftalmológico
| Resumo: | Introduction: Sarcoidosis is a multisystem disorder of unknown origin, whose histological hallmark is the presence of noncaseating granulomas. When sarcoidosis lesions affect the optic nerve, we are in the presence of neurosarcoidosis with neuro-ophtalmological involvement. The diagnosis and treatment is a challenge, and the prognosis is highly variable, from spontaneous remission to chronic and progres-sive disease. Purpose: To describe the evolution of a case, from the moment that the first complaints arise, to the present day – for five years, focusing on diagnosis and treatment, as well as the adverse effects associ-ated with the drugs. Case report: 36 year old female patient, with recurrent complaints of headache and bilateral decreased vision, with 4 months of evolution. Cranial nuclear magnetic resonance revealed a contrast-enhanced lesion adjacent to the optic chiasm. Corticosteroid therapy was initiated, with subjective improvement of vision. Because the patient was corticodependent, a biopsy of the right optic nerve was performed, which revealed neurosarcoidosis. Patient developed several comorbidities as a consequence of cortico-therapy, so other immunosuppressive drugs have been used, methotrexate to which the patient is refrac-tory; and subsequently infliximab, obtaining stability of visual function. Conclusions: When only the nervous system is affected, it’s very difficult to obtain a definite diagno-sis, taking into account the risk/benefit of biopsies in these cases. In the presence of a definite diagnosis, still remains the question of therapy, and sometimes is necessary to use medication with numerous adverse effects in order to stabilize the patient. |
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| Autores principais: | Cavaco, Sónia Isabel Pires |
| Assunto: | Oftalmologia Sarcoidose |
| Ano: | 2014 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso restrito |
| Instituição associada: | Universidade de Lisboa |
| Idioma: | português |
| Origem: | Repositório da Universidade de Lisboa |
| Resumo: | Introduction: Sarcoidosis is a multisystem disorder of unknown origin, whose histological hallmark is the presence of noncaseating granulomas. When sarcoidosis lesions affect the optic nerve, we are in the presence of neurosarcoidosis with neuro-ophtalmological involvement. The diagnosis and treatment is a challenge, and the prognosis is highly variable, from spontaneous remission to chronic and progres-sive disease. Purpose: To describe the evolution of a case, from the moment that the first complaints arise, to the present day – for five years, focusing on diagnosis and treatment, as well as the adverse effects associ-ated with the drugs. Case report: 36 year old female patient, with recurrent complaints of headache and bilateral decreased vision, with 4 months of evolution. Cranial nuclear magnetic resonance revealed a contrast-enhanced lesion adjacent to the optic chiasm. Corticosteroid therapy was initiated, with subjective improvement of vision. Because the patient was corticodependent, a biopsy of the right optic nerve was performed, which revealed neurosarcoidosis. Patient developed several comorbidities as a consequence of cortico-therapy, so other immunosuppressive drugs have been used, methotrexate to which the patient is refrac-tory; and subsequently infliximab, obtaining stability of visual function. Conclusions: When only the nervous system is affected, it’s very difficult to obtain a definite diagno-sis, taking into account the risk/benefit of biopsies in these cases. In the presence of a definite diagnosis, still remains the question of therapy, and sometimes is necessary to use medication with numerous adverse effects in order to stabilize the patient. |
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