Neovascular Glaucoma as a Presenting Sign of Catastrophic Antiphospholipid Syndrome with a "catastrophic" Heart Valve Finding

Anya Grinberg*, Mohamad Midlij, Beatrice Tiosano, Roni Shreter, Anat Kesler

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

We aimed to describe a case of neovascular glaucoma (NVG) as a first presenting sign of catastrophic antiphospholipid syndrome (CAPS) with heart valve aseptic vegetations known as Libman-Sacks endocarditis. A 39-year-old man was referred for left eye decreased visual acuity and pain, upon examination left eye high intraocular pressure; rubeosis iridis of both eyes (BE); and prominent retinal ischemia. Clinical and fluorescein angiography findings established the diagnosis of left eye NVG with vaso-occlusive disease in BE. Magnetic resonance imaging of the head showed widespread ischemic lesions and hemorrhagic foci. The transesophageal echocardiogram showed 2 big mitral valve lesions consistent with the diagnosis of Libman-Sacks endocarditis. Laboratory and clinical diagnosis of CAPS and suspected SLE was confirmed, and treatment with anticoagulants and IV steroids was initiated. This case demonstrates that severe vaso-occlusive retinopathy with severe brain ischemia should raise the suspicion of systemic autoimmune pro-coagulative diseases with heart valve aseptic vegetations.

Original languageEnglish
Pages (from-to)664-669
Number of pages6
JournalCase Reports in Ophthalmology
Volume12
Issue number2
DOIs
StatePublished - 20 Jul 2021

Keywords

  • Catastrophic antiphospholipid syndrome
  • Libman-Sacks endocarditis
  • Neovascular glaucoma
  • SLE
  • Vaso-occlusive retinopathy

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