Vision loss as presenting symptom of Takayasu arteritis

BMJ Case Report authors have described their treatment of a patient who presented with bilateral vision loss as a result of Takayasu arteritis.

The patient presented to hospital with vision limited to counting fingers at four metres in his right eye and no light perception in his left eye.

The patient, who was in his 50s, had a history of smoking and alcoholism, but did not report any history of systemic illness.

Fundus examination revealed scattered cotton wool spots in the posterior pole of his right eye with patchy retinal whitening and pallid disc oedema with central retinal artery occlusion in his left eye.

Due to the patient’s bilateral ocular ischaemia, a systemic evaluation was completed, resulting in a diagnosis of Takayasu arteritis.

Following eight weeks of systemic steroid treatment, the cotton wool spots had improved and the patient’s vision improved to 6/36 in his right eye.

The clinicians highlighted that atypical presentation of Takayasu arteritis should be borne in mind in cases with extensive bilateral ocular ischaemia.

“Ocular involvement may be the first presenting feature of many systemic vasculitic disorders including Takayasu arteritis,” they added.