Vasculitis associated with the use of an intrauterine device: A case report

Abstract

Retinal vasculitis is a complication associated with a local condition or it can be a retinal expression of a systemic inflammatory disorder, which initially may go unnoticed. Drug-associated vasculitis is frequently difficult to identify, because many patients follow treatments with more than one drug and the route of administration varies. A 35-year-old female patient presented with sudden hearing loss, headache and blurred vision that had started two weeks earlier and had become progressively worse. Ophthalmological examination revealed anterior uveitis, bilateral optic disc swelling and retinal vasculitis. The orbito-cerebral MRI, the CT scan and the serological tests were within normal limits. Unable to identify the cause of the retinal vasculitis, the patient's medical history was reviewed. The patient had recently had a gynecological procedure, where a 13.5 mg levonorgestrel intrauterine contraceptive device was implanted. After the device was removed and methylprednisolone treatment started, the patient presented a visible remission of the symptoms and signs. To the best of our knowledge, there is no case of retinal disease and optic disc edema associated with auditory problems caused by an intrauterine device. A proper examination, correlated with a very thorough medical history, could identify rare diseases and associations, in order to provide adequate medical care.

Keywords: bilateral optic disc edema; hearing loss; hormonal intrauterine device; immune response; methylprednisolone pulse therapy; vasculitis.

Figure 1

Fundus photography and fluorescein angiography during clinical assessment. (A) The appearance of the posterior pole and (B) fundus angiography in the right eye at 53.3 sec. (C) Fundus angiography in the right eye at 8 min and 3 sec. (D) The appearance of the posterior pole in the left eye on fundus photography. (E) Fundus angiography in the left eye at 1 min and 54 sec and (F) at 8 min and 41 sec.

Figure 2

Fundus photography and fluorescein angiography after the IUD was removed and steroid treatment started. (A) The appearance of the posterior pole in the right eye on fundus photography and (B) fundus angiography in the right eye at 50.6 sec (C) and at 3 min and 51 sec. (D) Appearance of the posterior pole in the left eye on fundus photography. (E) Fundus angiography in the left eye at 1 min and 2 sec and (F) at 4 min and 33 sec.

Figure 3

The OCT examination (A) prior to and (B) after one month of treatment.