PMC3910236_01
Fundoscopic examination at the beginning and after treatment. The initial fundoscopic examination of the right eye (A) shows a peripheral necrotizing retinitis and periarteritis (arrow). The follow-up examination after treatment (B) of the left eye presents an extensive posterior retinal necrosis (pentangle) and pigmentary changes of affected areas (arrow).
1742-2094-11-19-1.jpg
PMC3910236_01_1742-2094-11-19-1.jpg
F1
The posterior segment revealed an occlusive periarteriitis and a patchy necrotizing retinitis (Figure  1A-B).
Brain magnetic resonance imaging (MRI) at the initial presentation and after two months. Brain MRI five days after admission (A-D) shows a FLAIR-weighted image with non-active MS typical lesions (B), a diffusion-weighted image illustrating multiple dot-shaped cortical and subcortical lesions with restricted diffusion not limited to a large-vessel vascular territory and corresponding reduction on the apparent diffusion coefficient sequence (B,C), a contrast enhanced T1-weighted image without any intracerebral contrast enhancement (D; circular contrast uptake of the cerebral meninges due to a previous lumbar puncture). The follow-up MRI after two months (E-F) shows a diffusion-weighted image without any new lesions (E) and a contrast enhanced T1-weighted image with dot-shaped contrast-enhancing lesions (F) in contrast to the initial presentation.
1742-2094-11-19-2.jpg
PMC3910236_01_1742-2094-11-19-2.jpg
F2
Besides the known non-active multiple sclerosis (MS)-typical lesions, the cranial magnetic resonance imaging (MRI) displayed multiple new dot-shaped cortical and subcortical lesions with diffusion restrictions that were not limited to a large-vessel vascular territory (Figure  2A-D). This was interpreted as an ongoing immune response related to the apparently still active vasculitis (Figure  2E-F).