Korean J Ophthalmol.  2010 Aug;24(4):256-259. 10.3341/kjo.2010.24.4.256.

Optic Neuropathy Associated with Castleman Disease

• Kim U
• Hwang JM

• KMID: 949067
• DOI: http://doi.org/10.3341/kjo.2010.24.4.256

Abstract

A 44-year-old woman with Castleman disease presented with acute visual loss in the left eye. A full ophthalmologic examination and imaging were performed. Visual acuity was 20/20 in the right eye and 20/100 in the left eye. Total dyschromatopsia, a relative afferent pupillary defect, and a cecocentral scotoma were observed in the left eye. Mild disc edema, without leaking during fluorescein angiography, was also observed. Magnetic resonance imaging revealed a small cystic epidermoid-like lesion in the right prepontine and suprasellar cistern. Her visual acuity did not improve and deteriorated to 20/200 in the left eye at 22 months after the initial visual loss. Optic neuropathy may rarely be associated with Castleman disease and suggests a poor prognosis.

Keyword

Castleman disease; Giant lymph node hyperplasia; Optic nerve diseases

MeSH Terms

Adult
Diagnosis, Differential
Disease Progression
Female
Fluorescein Angiography
Fundus Oculi
Giant Lymph Node Hyperplasia/*complications/diagnosis
Humans
Magnetic Resonance Imaging
Optic Nerve Diseases/diagnosis/*etiology/physiopathology
Tomography, Optical Coherence
Visual Acuity
Visual Field Tests
Visual Fields

Figure

• 

  Fig. 1 (A) Goldmann visual field examination showed a cecocentral scotoma and inferonasal visual field defect one day after the onset of visual loss. (B) The visual field defect improved to a central scotoma 40 days after the onset of visual loss. (C) Mild disc swelling was observed on fundus photography. (D) Fluorescein angiography demonstrated mild disc edema without leakage.

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  Fig. 2 Magnetic resonance imaging revealed an epidermoid-like mass in the right prepontine and suprasella cistern (arrow). (A,B) T2-weighted images. (C) Gadolinium enhanced T2-weighted image. (D) T1-weighted sagittal image.

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  Fig. 3 Twenty-two months later, optical coherence tomography showed a diffuse decrease in retinal nerve fiber layer thickness in the left eye. TEMP=temporal; SUP=superior; NAS=nasal; INF=inferior; Imax=inferior maximum; Smax=superior maximum; Navg=nasal average; Savg=superior average; Tavg=temporal average; Iavg=inferior average.

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