ANCA-associated small vessel vasculitis presenting with ischemic optic neuropathy

Abstract

The development of serologic tests for antineutrophil cytoplasmic antibodies (ANCA) has enabled a better characterization of the small vessel vasculitides that include Wegener’s granulomatosis, Churg–Strauss syndrome, and microscopic polyangiitis.1 ANCA-associated vasculitides can involve the central and peripheral nervous systems.2 This report summarizes the case of a patient who sought treatment for ischemic optic neuropathy, an unusual complication of these disorders. A 67-year-old man was referred for evaluation of partial loss of vision of the right eye. Symptoms had started suddenly approximately 4 weeks before the examination, and the patient described an area of decreased vision, or “haze,” close to the center of the eye’s visual field. The systems review was positive for occasional blood-tinged sputum of 1-year duration, chronic joint pains, hypertension, and hyperlipidemia. There was no history of fever, weight loss, or jaw claudication. The neurologic examination, including palpation of the preauricular and forehead arteries, was normal. Funduscopic examination showed …