RETINAL VASCULITIS IN A PATIENT WITH HANSEN DISEASE.

Abstract

Purpose: Hansen disease is endemic in over 140 countries worldwide and a potentially blinding condition. The authors describe a case of retinal vasculitis in a patient with Hansen disease with concomitant positive antiphospholipid antibody serology, a potentially underreported complication in this setting.

Methods: A 37-year-old Brazilian man systemically stable on triple therapy (clofazimine, rifampin, and dapsone) for Hansen disease presented for a comprehensive ophthalmic evaluation.

Results: Dilated examination revealed diffuse peripheral intraretinal hemorrhages in his right eye. Fluorescein angiography showed peripheral nonperfusion, abnormal shunt vessels and leakage from the retinal veins in the right eye, and peripheral nonperfusion and vascular leakage in the fellow eye, consistent with vasculitis. Laboratory workup was notable for positive antiphospholipid antibodies (lupus anticoagulant, anticardiolipin immunoglobulin M (IgM), and anti-beta-2 glycoprotein 1 IgM) and normocytic anemia.

Conclusion: As antiphospholipid antibodies are present in a large proportion of patients with Hansen disease, it is possible that retinal vasculitis may be more common than previously thought. The extent to which retinal vasculitis occurs in patients with Hansen disease remains uncertain and possibly underestimated due to the frequency of anterior segment scarring, which impedes retinal evaluation. Heightened surveillance for potential retinal vascular complications is warranted.