Título

FROSTED-BRANCH ANGIITIS - CASE REPORT

Objetivo

Report a typical case of Frosted-Branch Angiitis, which is an extremely rare disorder.

Relato do Caso

SA, 42 years old, male, painter. Main complaint: low visual acuity both eyes for 12 hours, and violaceous lesions on lower limbs 7 days ago and polyarthritis 2 days ago. Past history: Overlapping Lupus and Sjogren's Syndrome, in use of azathioprine, hydroxychloroquine and prednisone. Ocular examination: visual acuity: OD: count fingers 0,5m and OS count fingers 0,2m. Biomicroscopy OU: calm eye, anterior chamber reaction 4+/4+. Fundoscopy OU: frosted-branch angiitis. Vitreous cells in posterior pole OS. Hypotheses: Frosted-Branch Angiitis. Secondary to cytomegalovirus? Herpes? Lupus? Management: Ceftriaxone 2g twice/day; Oxacillin 2g 6 times/day; Ganciclovir twice/day and Dexamethasone 4mg 4 times/day. One day later: severe vitritis. Management: Aciclovir 500mg 3 times/day, Dexamethasone 10mg EV 4 times/day; Predfort 2/2h and Mydriacyl twice/day. Patient reported improvement of  the visual acuity after treatment. One week after: visual acuity OD counts fingers 2m and OS counts fingers 3m. Fundus: vitreous cellularity, improvement of vasculitis and hemorrhages. One month later: discrete pallor of the optic nerve. The same visual acuity. Angiofluorography was performed, which did not show severe retinal change.

Conclusão

Frosted branch angiitis is a rare disorder. It affects most children or young adults, usually bilaterally. It is a diffuse perivasculitis wich can cause severe visual loss. There is widespread translucent sheathing of both retinal arterioles and venules. The cause is Unknown, has been suggested that an immune reaction may be responsible. This retinal vasculitis may also occur in association with pre-existing intraocular inflammation caused by cytomegalovirus, herpes simplex, toxoplasmosis, Behçet’s disease, systemic lupus erythematosus, leukaemia, lymphoma or Crohn’s disease. The condition probably resolves spontaneously in most cases, but responds rapidly to corticosteroids. Visual recovery may happen, with some exceptions.