Catastrophic antiphospholipid antibody syndrome and cocaine abuse associated with bilateral retinal vascular occlusions

John Campbell, Bryn M. Burkholder, James P. Dunn

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: To describe a case of bilateral central retinal vein occlusion and central retinal artery occlusion associated with antiphospholipid antibody syndrome and cocaine abuse. Methods: A single case report of a 44-year-old woman with a history of cocaine abuse, vasculitis, and 3 spontaneous abortions who developed painless complete loss of vision in both eyes concurrently with progressive motor and sensory polyneuropathy. The patient underwent an extensive laboratory, radiographic, ophthalmologic, and pathologic workup. Results: Diagnosis of catastrophic antiphospholipid antibody syndrome was made based on established clinical and laboratory criteria, including a positive Russell's viper venom test, history of three spontaneous abortions and evidence of microvascular and macrovascular venous occlusions, and multiorgan failure. Urine toxicology screen was positive for cocaine metabolites. Her clinical course was remarkable for progressive mononeuritis multiplex and quadriplegia. She had no light perception on presentation, and fundus examination revealed extensive preretinal, intraretinal, and subretinal hemorrhages. Fluorescein angiography revealed complete occlusion of central retinal arteriolar and venular flow and retinal hemorrhages in both eyes. Conclusion: Bilateral central retinal vein occlusion and central retinal artery occlusion have been rarely reported in the literature and are often associated with underlying thrombotic risk factors, such as antiphospholipid antibody syndrome. Workup for underlying hypercoagulability and/or cocaine use should be considered in atypical and bilateral cases of central vein or artery occlusion. In this case, bilateral central retinal artery and vein occlusions developed as manifestations of catastrophic antiphospholipid antibody syndrome, which has not been previously reported.

Original languageEnglish (US)
Pages (from-to)318-322
Number of pages5
JournalRetinal Cases and Brief Reports
Volume5
Issue number4
DOIs
StatePublished - Sep 2011
Externally publishedYes

Fingerprint

Retinal Vessels
Cocaine-Related Disorders
Antiphospholipid Syndrome
Retinal Artery Occlusion
Retinal Vein
Retinal Vein Occlusion
Spontaneous Abortion
Cocaine
Russell's Viper
Viper Venoms
Mononeuropathies
Retinal Hemorrhage
Quadriplegia
Thrombophilia
Polyneuropathies
Fluorescein Angiography
Vasculitis
Toxicology
Veins
Arteries

Keywords

  • Antiphospholipid antibody syndrome
  • Cocaine
  • CRAO
  • CRVO
  • Vasculitis

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Catastrophic antiphospholipid antibody syndrome and cocaine abuse associated with bilateral retinal vascular occlusions. / Campbell, John; Burkholder, Bryn M.; Dunn, James P.

In: Retinal Cases and Brief Reports, Vol. 5, No. 4, 09.2011, p. 318-322.

Research output: Contribution to journalArticle

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