Ocular immunology and inflammation · 2025
Development of Superficial Thrombophlebitis and Subsequent Central Retinal Vein Occlusion Occurring in a Patient Receiving IVIg for Ocular Pemphigoid.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Truong-Balderas Kevin, Mihailescu Maria, Tu Grace, Tu Elmer, Amber Kyle T
Аннотация
PURPOSE: To describe a case of ocular mucous membrane pemphigoid (oMMP) complicated by recurrent superficial thrombophlebitis (STP) and central retinal vein occlusion (CRVO) during intravenous immunoglobulin (IVIg) therapy.
METHODS: Observational case report.
RESULTS: A 43-year-old male developed STP in the left dorsal hand and forearm following the first and third months of IVIg therapy. Despite conservative management, the patient presented with acute right-eye vision loss after the fifth infusion cycle, and fundus examination confirmed non-ischemic CRVO. Laboratory workup revealed elevated anti-cardiolipin IgM antibodies, indicating a prothrombotic state. IVIg was discontinued and replaced with systemic anticoagulation and rituximab. An intravitreal injection for macular edema led to partial recovery of visual acuity (20/25) following subsequent cataract extraction, though a residual paracentral scotoma persisted.
CONCLUSION: IVIg can effectively control severe oMMP but may increase the risk of thromboembolic events in predisposed individuals. Recurrent STP during IVIg therapy may serve as an early indicator of a more serious vascular complication, such as CRVO. Recognizing and investigating hypercoagulability in these patients is critical for preventing irreversible vision loss and guiding safer therapeutic strategies.
METHODS: Observational case report.
RESULTS: A 43-year-old male developed STP in the left dorsal hand and forearm following the first and third months of IVIg therapy. Despite conservative management, the patient presented with acute right-eye vision loss after the fifth infusion cycle, and fundus examination confirmed non-ischemic CRVO. Laboratory workup revealed elevated anti-cardiolipin IgM antibodies, indicating a prothrombotic state. IVIg was discontinued and replaced with systemic anticoagulation and rituximab. An intravitreal injection for macular edema led to partial recovery of visual acuity (20/25) following subsequent cataract extraction, though a residual paracentral scotoma persisted.
CONCLUSION: IVIg can effectively control severe oMMP but may increase the risk of thromboembolic events in predisposed individuals. Recurrent STP during IVIg therapy may serve as an early indicator of a more serious vascular complication, such as CRVO. Recognizing and investigating hypercoagulability in these patients is critical for preventing irreversible vision loss and guiding safer therapeutic strategies.