Diffuse Unilateral Sub-acute Neuroretinitis.pptx

DUSN is very rare ophthalmic disease, generally affecting young people.

1. A case presentation on Diffuse Unilateral Sub-acute Neuroretinitis (DUSN) Dr. Ranjita Amanatya PG 3 rd year VIMSAR, BURLA

2. History of past illness: - HOPI :- A 30 yrs old female presented at EYE OPD with complaint of Gradual diminution of vision in BES with pain & watering since 3months. Diagnosed case of R.E. Papillitis with CSR 4years ago. No h/o trauma,F.B . exposure. Exposure to cats No recent viral illness/vaccinations No recent pyrexia, fatigue, cough/sore throat Not a k/c/o HTN, Diabetes, Thyroid disease, Sickle cell disease.

3. Title text GENERAL PHYSICAL EXAMINATION:- GENERAL EXAMIATION:- Conscious, oriented to time, place & person No pallor, icterus, clubbing , lymphadenopathy B .P.:- 124/82 mmHg P .R.:- 92 beats/min SYSTEMIC EXAMINATION:- Chest:- B/L symmetrical VBS heard CVS :-S1 S2 no murmur CNS :- NAD

4. Ocular examination V.A. 6/12 6/6 I.O.P. 11.5mmHg 12.3mmHg Colour Vision Defective Normal Lids & Adnexa Normal Normal Conjunctiva Normal Normal Cornea Clear Clear A.C. WNL WNL Pupil Circular/LR(+) Circular/LR(+) Lens Clear Clear OD OS

5. Macula:- FR Absent, Healed Choroiditis patches Dilated Fundoscopy (R.E.) Optic Disc:- Shape:-Normal Size:-Normal Colour :-Hyperemic Margin:-Well defined C:D Ratio:- Obliterated B.V.:- Attenuated Periphery:- Healed Choroiditis patches in all 4 quadrants

6. Optic Disc:- C:D Ratio:- Macula:- B.V.:- Periphery:- Shape:-Normal Size:-Normal Colour :-Normal Margin:-Well defined 0.3 FR (+ nt ) Normal Normal Dilated Fundoscopy (L.E.)

7. OCT image (R.E.):-

8. OCT image (R.E.):-

9. OCT image (L.E.):-

10. 03 02 06 04 05 01 INVESTIGATION:- Complete Blood Count:- WNL Urine (Routine & Microscopic):- Within normal limit HBsAg, H.I.V., H.C.V. :- Non-reactive Lipid profile:- Within normal limit ESR :- 35mm CRP:- 35mg/L

11. PROVISIONAL DIAGNOSIS:- Diffuse Unilateral Sub-acute Neuroretinitis (DUSN) in R.E.

12. DIFFERENTIAL DIAGNOSIS:- Toxoplasma Toxocara TB Syphilis Borrelia burgdorferi Post streptococcal syndrome Sarcoidosis Multifocal choroiditis Other white dot syndromes

13. 01 02 03 04 E/d Prednisolone 1 drop 4times (R.E.) Tab Albendazole (400mg) 1tab OD for 7days MANAGEMENT:-

14. DISCUSSION Diffuse Unilateral Sub-acute Neuroretinitis (DUSN) is an inflammatory disease capable of involving multiple ocular structures, such as Retina, retinal vessels, RPE & O.N. Infection of the eye by a nematode was first reported in the year 1950 by Wilder in enucleated eye specimens. Parsons provided the first report of a subretinal mobile worm causing an ocular syndrome in 1952. Gass first described DUSN in 1977 . Association with nematode was proposed in 1983. Parasitic organisms such as Baylisascaris , Ancylostoma caninum & Toxocara canis involved in it’s etiology, leading to characteristic retinal lesions, including focal chorioretinal atrophic scars. Ocular toxoplasmosis is the M.C.C. of infectious retinitis. Prevalent in young individuals. Rare cause of posterior uveitis. Mostly U/L chorioretinitis.

15. DISCUSSION Cont.:- C/F:- EARLY STAGE:- Mild loss of V.A. Vitritis Papillitis Retinal vasculitis O.D. Edema Gray-White/Yellow-White evanescent lesions in deep retinal layers RPE changes LATE STAGE:- Severe loss of V.A. Multifocal choroiditis Increase in the ILM reflex(Orefice’s sign) Diffuse retinal atrophy Degenerative RPE Changes Optic atrophy Retinal arteriole narrowing DUSN should always be suspected in healthy patients with uni­lateral insidious loss of vision, vitreous inflammation, retinal vasculitis, multifocal lesions involving deep retinal layers, narrowing of retinal vessels, or optic atrophy. Disease having an immuno­logical element, corticosteroids associated with both high-dose albendazole and laser therapy could be beneficial.

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