Choroidal infarction, anterior ischemic optic neuropathy, and central retinal artery occlusion from polyarteritis nodosa

Purpose: Ocular ischemia from Polyarteritis nodosa (PAN) is rare. The autho rs present a case of multifocal Ocular infarction from PAN. Methods and Results: A 70-year-old woman developed hand and foot numbness f ollowed by intermittent blurred vision and binocular horizontal diplopia. T wo weeks later, she suddenly lost vision in the right eye from a central re tinal artery occlusion and then developed a left anterior ischemic optic ne uropathy and bilateral triangular choroidal abnormalities consistent with i nfarction. Her erythrocyte sedimentation rate and C-reactive protein were e levated. Although giant cell arteritis was suspected, a multiple mononeurop athy was demonstrated by electromyogram and nerve conduction velocity studi es. Biopsy specimens from her sural nerve and biceps muscle showed a necrot izing vasculitis with fibrinoid necrosis, consistent with PAN. Conclusions: Polyarteritis nodosa can produce ischemia of a variety of ocul ar structures, including the retina, choroid, and optic nerve. In our patie nt, all three structures were affected. To our knowledge, this is the first reported case of the triangular sign of Amalric in PAN.