(AS) (MM) Wills Eye Hospital, Philadelphia, Pennsylvania; (JG) Thomas Jefferson University, Philadelphia, Pennsylvania
Subject
Progressive Multifocal Leukoencephalopathy, Vision Loss Binocular, Immunodeficiency, Vasculitides, JC Virus
History
A 78-year old woman with 3-week history of sudden onset 'visual blur' OU and difficulty reading was evaluated by her ophthalmologist and suspected to have macular hole secondary to posterior vitreous detachment and vitreomacular traction (VMT). Her past medical history was significant for hypertension, hyperlipidemia, depression and carcinoid tumor of the appendix. She consulted a retina specialist who confirmed bilateral VMT and advised follow up with regular ophthalmologist. Her visual acuity at presentation was 20/60 OD and 20/50 OS. She returned 2 weeks later with worsening vision loss and no change in retinal findings, at which point she was referred for neuro-ophthalmic consultation. At her first neuro-ophthalmology visit, vision was count fingers close to face OD and hand motion OS. Pupils were sluggish with no afferent pupillary defect. Dilated fundus exam revealed normal optic discs, epiretinal membrane and VMT OU. On further questioning, she reported being treated with prednisone for the past year by rheumatology for a 'presumed vasculitis' after she had symptoms of fever, weight loss, rash, lower extremity edema, lack of energy and skin nodules. She denied headache, jaw claudication and scalp tenderness.
Disease/Diagnosis
Progressive Multifocal Leukoencephalopathy with underlying angioimmunoblastic T-Cell lymphoma
Date
2020-03
References
None.
Language
eng
Format
video/mp4
Type
Image/MovingImage
Source
2020 North American Neuro-Ophthalmology Society Annual Meeting
Relation is Part of
NANOS Annual Meeting Frank B. Walsh Sessions; 2020
