Bilateral acute angle-closure glaucoma as a first presentation of granulomatosis with polyangiitis (Wegener's)

ABSTRACT We report a case of bilateral acute angle-closure glaucoma in a patient with undiagnosed granulomatosis with polyangiitis (Wegener's). A 59-year-old man presented with a severe headache, ocular pain, blurred vision, shortness of breath, and mild fever. Clinical examination revealed conjunctival chemosis, corneal edema, and shallow anterior chambers. Closed angles were observed bilaterally on gonioscopy. The patient was treated with intravenous mannitol, oral acetazolamide, and anti-glaucomatous eye drops. Over the following two days, his vision improved and intraocular pressures decreased. Subsequently, laser iridotomies were performed bilaterally and the patient attended consultations with our departments of respiratory medicine, nephrology, and rheumatology and was subsequently diagnosed with granulomatosis with polyangiitis. Bilateral acute angle-closure glaucoma is a very rare ocular manifestation of granulomatosis with polyangiitis. The association of this clinical entity with Wegener's granulomatosis remains unknown.

摘要
本文报告1例未确诊的肉芽肿性多血管炎（granulomatosis with polyangiitis，韦格纳肉芽肿(Wegener's)）患者并发双侧急性闭角型青光眼的病例。患者为59岁男性，因剧烈头痛、眼痛、视力模糊、呼吸困难及低热就诊。体格检查可见球结膜水肿、角膜水肿及前房变浅；前房角镜检查显示双侧房角关闭。予静脉输注甘露醇、口服乙酰唑胺及抗青光眼滴眼液治疗。后续两日，患者视力好转，眼内压下降。随后为患者行双侧激光虹膜切开术，患者先后至我院呼吸内科、肾内科及风湿免疫科会诊，最终确诊为肉芽肿性多血管炎。双侧急性闭角型青光眼是肉芽肿性多血管炎极为罕见的眼部表现，该临床病症与韦格纳肉芽肿的关联机制目前仍不明确。