PMC3898010_01
Photographs at the first visit (a-f) and two weeks after (g, h) in a 67-year-old neuroretinitis patient with small cell lung carcinoma. Fundus photograph showing optic disc swelling surrounded by serous retinal detachment (SRD) and dilated tortuous veins in both eyes, and a subretinal opaque exudation at the fovea in the right eye (a, right eye, b, left eye). Fluorescein angiography of the right eye showing hyperfluorecence corresponding to the foveal lesion and the optic disc 140 second after the dye injection (c), and the foveal tissue staining, marked leakage from the optic disc, and retinal vasculitis (arrows) on the late phase (d). Horizontal section of optical coherence tomography (OCT) showing a dome-shaped hyperreflective lesion at the fovea and SRD (e, arrow) adjacent to the optic disc in the right eye (e). Horizontal OCT showing intact the photoreceptor inner segment/outer segment junction (IS/OS) line at the macula in the left eye (f). SRD extended to the macula in the left eye (g, arrow). Single-flash electroretinography demonstrated normal a-wave in both eyes and slightly reduced b-wave in the left eye (h).
1471-2415-14-5-1.jpg
PMC3898010_01_1471-2415-14-5-1.jpg
F1
Funduscopy revealed swollen optic disc surrounded by serous retinal detachment (SRD), dilated tortuous veins OU, and subretinal opaque exudation at the fovea OD (Figure 1a,b). Fluorescein angiography showed initial hyperfluorescence with late leakages from the optic disc and retinal venous wall staining OU, and hyperfluorescence from the initial phase at the fovea OD (Figure 1c,d). OU except for slight hypofluorescence on the late phase corresponding to the foveal lesion OD. Optical coherence tomography (OCT) showed SRD adjacent to the optic disc OU and a dome-shaped hyperreflective lesion that extended from the inner nuclear layer to the photoreceptor layer corresponding to the foveal exudation OD (Figure 1e). In the left eye, the photoreceptor inner segment/outer segment junction (IS/OS) line was intact at the macula (Figure 1f). SRD at the macula OS (Figure 1g). Single bright-flash electroretinography (ERG) showed normal a-wave OU and slightly reduced b-wave OS (Figure 1h).
Photographs 5 months after systemic corticosteroid treatment. Fundus photographs showing the disappearance of the optic disc swelling and SRD in both eyes and foveal scar formation in the right eye (a, right eye, b, left eye). Horizontal OCT showing the disappearance of SRD in both eyes and a foveal hyperreflective lesion in the right eye, with intact IS/OS line in the left eye (c, right eye, d, left eye).
1471-2415-14-5-2.jpg
PMC3898010_01_1471-2415-14-5-2.jpg
F2
OU with foveal scar formation OD (Figure 2a,b). On OCT, SRD and a foveal hyperreflective lesion disappeared with intact IS/OS line OS (Figure 2c,d).
Immunoblotting results in our patient. Immunoblot analyses revealed predicted protein bands of approximately 49 kDa [recombinant human recoverin (23 kDa)-fusion GST (glutathione S-transferase, 26 kDa) protein] (a), 88 kDa [recombinant human CRMP-5 (62 kDa)-fusion GST protein] (b), and 46 kDa [recombinant human alpha-enolase (46 kDa)] (c) in the patient's and control's sera.
1471-2415-14-5-3.jpg
PMC3898010_01_1471-2415-14-5-3.jpg
F3
CRMP-5, and alpha-enolase (Figure 3), but not carbonic anhydrase II (data not shown). Chemotherapy was discontinued because imaging showed near-complete disappearance of lung carcinoma.