Diagnostic and therapeutic challenges

摘要

This case is submitted by Kevin M. Cronin, BA, Drs. Rebecca A. Manning, and Charles P. Richards of Wake Forest Eye Center, Wake Forest School of Medicine, Winston-Salem, North Carolina; commented by Dr. Aniki Rothova, Rotterdam, The Netherlands, and Dr. Khalid F. Tabbara, Riyadh, Saudi Arabia.An 11-year-old African American girl presented to the ophthalmology clinic with a 2-month history of progressive vision loss with no associated discomfort. Her medical history for the past 8 months is notable for fatigue, decreased appetite, a 10-pound weight loss, left-sided temporal headaches, shortness of breath, dyspnea on exertion, intermittent abdominal pain, diarrhea, muscle aches, night sweats, and subjective fevers. The patient's recent history is also notable for rhinorrhea and mild coughing productive of yellow sputum in the past 2 weeks, 3 episodes of emesis in the past week, and occasional erythematous and praritic skin rashes on her trunk and limbs that began 8 months ago. The patient's medical history was otherwise noncontributory, with normal development, up-to-date on immunizations, and currently on no medications except for a daily multivitamin. The patient's family history was positive for thyroid disease and ankylosing spondylitis in distant relatives.