Occlusive retinal vasculitis (ORV) is a challenging and sight threatening condition. We present a case of ORV associated with large neovascularization, vitreous hemorrhage in a healthy patient with no history of medical issues, which turned out to have multiple sclerosis (MS).
We present the case of a 26 years-old man complaining about vision loss on his right eye. The visual acuity was 3/10 on the RE and 8/10 on the LE. Anterior chamber was calm on both eyes. Ophthalmoscopy showed slight vitreous hemorrhage, multiple retinal hemorrhages, and snowballs. Fluorescein angiography revealed severe occlusive retinal periphlebitis with several zones of blocking effect, corresponding to retinal hemorrhages, large areas of nonperfusion with multiple zones of retinal neovascularization and papillitis.
A classical workup for retinal vasculitis was done: blood sample to exclude syphilis, tuberculosis, sarcoidosis, toxoplasmosis; chest CT scan for sarcoidosis and tuberculosis lesions, and cerebral MRI to exclude white matter lesions. Waiting for the results, we decided to inject Bevacizumab and instill topic corticoids drops every hour. Once the work up showed no infection, methylprednisone 64 mg and retinal laser treatment were started. The MRI revealed white matter lesions compatible with MS. Neurological work up confirmed the diagnosis and was considered as an etiology to this posterior uveitis.
Optic neuritis is the most frequent ophthalmic manifestation in MS, but uveitis can occur and be the first warning sign of this underlying condition. Our patient presented periphlebitis, which is well-known in MS, but the occlusive aspect and the large and diffuse neovascularization remain a rare condition in MS. That kind of ORV presentation should lead to a workup including an MRI.