A man in his 40s with blurry vision in both eyes presented with headaches, arthritis, anorexia, and weight loss. Visual acuity was counting fingers OD and hand motions OS. Examination revealed a flat nasal bridge, anterior chamber cells, and vitreous cells (in addition to the posterior segment findings described in the Figure legend). Workup revealed antineutrophil cytoplasmic antibody (proteinase 3 antineutrophil cytoplasmic antibody) positivity, consistent with granulomatosis with polyangiitis. Treatment with systemic steroids was initiated and transitioned to methotrexate, cyclosporine, and infliximab. The systemic symptoms and ophthalmic findings improved.
Yonekawa Y, Thanos A, Faia LJ. Ultra-Widefield Imaging in Granulomatosis With Polyangiitis. JAMA Ophthalmol. 2016;134(7):e160034. doi:10.1001/jamaophthalmol.2016.0034