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JAMA Ophthalmology Clinical Challenge
February 18, 2021

Unilateral Frosted Branch Angiitis in a Patient With Immunosuppression

Author Affiliations
  • 1Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
JAMA Ophthalmol. 2021;139(4):484-485. doi:10.1001/jamaophthalmol.2020.4684

A 49-year-old African American man who was hospitalized with hypervolemia due to supraventricular tachycardia presented with acute unilateral painless vision loss. His active medical problems included atrial flutter on anticoagulation, antisynthetase syndrome (which was diagnosed based on the presence of autoantibodies against aminoacyl-tRNA synthetase), fever with negative infectious workup results, and interstitial lung disease that was managed with azathioprine. Two weeks before the onset of sudden vision loss, the patient developed a rapidly evolving purpuric rash on his hands and feet that progressed to digital ischemia (Figure 1A). He was treated with intravenous methylprednisolone, which was completed 3 days before the onset of loss of vision and transitioned to treatment with azathioprine, 150 mg, and prednisone, 80 mg, that he was taking at the time of his vision loss.

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