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A case of relapsing polychondritis with optic neuritis as the first symptom Tomoko Ushida 1 , Hiroaki Ushida 1 , Keigo Natsume 1 , Ayana Suzumura 1 , Koji M. Nishiguchi 1 1Department of Ophthalmology, Nagoya University Graduate School of Medicine pp.505-510
Published Date 2024/4/15
DOI https://doi.org/10.11477/mf.1410215151
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Abstract Purpose:Ocular manifestations of recurrent polychondritis(RP)include scleritis, episcleritis, and uveitis, but optic neuritis is rare, occurring in only 0.9% of patients. We report a case of RP with optic neuritis as an early-onset manifestation.

Case:A 71-year-old man visited a clinic with a chief complaint of decreased visual acuity in his left eye. There were no abnormalities in his right eye. His left eye visual acuity was 0.2 with a left critical flicker fusion frequency(CFF)of 16.6 Hz and left optic disc swelling. His left eye had positive relative afferent pupillary defect, and Goldmann visual field testing showed a left central scotoma;accordingly, he was diagnosed with left optic neuritis and underwent steroid pulse therapy thrice. Although his left visual acuity improved to 0.8, it subsequently worsened and he was referred to our hospital.

Findings:At the time of the initial visit to our hospital, there was no visual loss in the right eye. However, the visual acuity of the left eye was 0.2. There was conjunctival edema, hyperemia of the sclera and conjunctiva, and macular edema in the left eye. In addition, the left optic nerve papilla was swollen. He was diagnosed with combined scleritis and optic neuritis. Subconjunctival steroid injections were administered for the left scleritis, and subtenon sac triamcinolone injections, were added. The optic neuritis in the left eye tended to improve. Chest CT showed inflammation mainly in the cartilage area, and an auricular cartilage biopsy was performed. He was diagnosed with RP owing to the presence of ocular inflammation, bilateral auricular chondritis, and airway chondritis. Oral prednisolone 60 mg was initiated, and left visual acuity improved to 0.3 and CFF improved to 20 Hz.

Conclusion:In cases of optic neuritis that repeatedly relapse, it is necessary to proceed with detailed examination and treatment, keeping in mind the possibility of RP.


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電子版ISSN 1882-1308 印刷版ISSN 0370-5579 医学書院

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