Clinicopathological Correlates: Chronic Arsenic Toxicity Causing Bilateral Symmetric Progressive Optic Neuropathy

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Title Clinicopathological Correlates: Chronic Arsenic Toxicity Causing Bilateral Symmetric Progressive Optic Neuropathy
Creator Paul Freund; Laila Al-Shafai; Gabriella Mankovskii; David Howarth; Edward Margolin
Affiliation Departments of Ophthalmology and Vision Sciences (PF, EM), and Medical Imaging (LA-S), Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Biomedical Physics (GM), Ryerson University, Toronto, Canada; Department of Laboratory Medicine (DH), University of Toronto, Toronto, Canada
Abstract A 70 year-old man presented with insidiously progressing central visual acuity loss in both eyes over several years. Objectively the only abnormality identified on the exam was questionable granularity in the fovea in each eye. Extensive work up which included neuro-imaging, screening blood work for toxic and nutritional causes of optic neuropathy as well as electroretinogram and fluorescein angiography to rule out subtle maculopathy was all unrevealing. When vision continued to deteriorate over the next several years investigations were repeated and again did not yield any positive results. Levels of heavy metals were then obtained after further progression of visual loss, revealing very high levels of arsenic. Subsequent investigations revealed that patient has been spending almost every weekend for the past 28 years alone at a remote country cottage where the sole supply of water was from the local well. He also recalled that 1.5 months after purchasing the cottage he developed hemorrhagic colitis requiring partial colectomy. The specimen from colectomy was located and total reflection x-ray fluorescence testing performed in a specialized lab revealed greatly increased level of arsenic particle in the colonic biopsy from 28 years ago. This case is a reminder that heavy metal toxicity should be considered in a differential diagnosis of patients with bilateral symmetric optic neuropathy.
Subject Aged; Arsenic Poisoning / complications; Arsenic Poisoning / diagnosis; Chronic Disease; Diagnosis, Differential; Disease Progression; Electroretinography; Fluorescein Angiography; Fundus Oculi; Humans; Male; Optic Nerve / drug effects; Optic Nerve / pathology; Optic Nerve Diseases / chemically induced; Optic Nerve Diseases / diagnosis; Visual Acuity
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Date 2020-09
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, September 2020, Volume 40, Issue 3
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s6md4pfv
Setname ehsl_novel_jno
ID 1592953
Reference URL https://collections.lib.utah.edu/ark:/87278/s6md4pfv
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