Ophthalmoscopic findings in 3 patients with panarteritis nodosa and reviewof the literature

Background: Ocular involvement in panarteritis nodosa (PAN) has been report ed to occur in 10 to 20% of patients. In 3 patients with acute Visual distu rbance we point out unusual findings. Patients: Case 1. A 40-year-old man initially presented with papilledema to gether with partial optic atrophy in both eyes, rater polyneuropathy, gangr ene of the toes and myalgic pains developed. Caliber changes in the small a rteries in the liver were seen angiographically and recognized as signs of PAN. Under treatment with cyclophosphamide und prednisone no relapse occurr ed during a follow-up of 2 years. Case 2. in a 67-year-old man who suffered from arterial hypertension and coronary heart disease, central retinal art ery occlusion occurred, at first in the left and then later in the right ey e. The clinically suspected diagnosis of PAN (arterial hypertension, myalgi a, polyneuropathy) was confirmed by a muscle biopsy. During a follow-up of 4 years - including treatment with prednisone and cyclophosphamide - no rel apse occurred. Case 3. A 16-year-old adolescent with throbbing headaches an d a thickened right temporal artery reported Visual disturbances. These wer e due to an inflammation of choroidal vessels of the right eye appearing as an initial sign of PAN. Histology revealed a necrotising arteritis of the temporal artery. He presented with signs of Raynaud's disease, cachexia and arterial hypertension. Multiple vasculitic changes were detected by aorto- arteriography. Five months after the visual deterioration an anterior spina l artery syndrome with quadriplegia developed. After a follow-up of 2 years and treatment with prednisone und cyclophosphamide, he still had paralysis of both legs. The Visual acuity was 1.0 in each eye. Conclusion: PAN should be considered in differential diagnosis in patients with acute inflammatory signs of the optic nerve head, the choroid and/or t he retina together with general signs of the disease. If the disease is sus pected, a muscle biopsy is indicated.