Autoimmune retinopathy and optic neuropathy associated with enolase-positive renal oncocytoma

Justine L Cheng; Johanna D Beebe; Kenneth G Nepple; Yousef Zakharia; Robert F Mullins; Miles J Flamme-Wiese; Matthew J Thurtell; Ian C Han

doi:10.1016/j.ajoc.2018.09.005

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Autoimmune retinopathy and optic neuropathy associated with enolase-positive renal oncocytoma

Journal article

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Autoimmune retinopathy and optic neuropathy associated with enolase-positive renal oncocytoma

Justine L Cheng, Johanna D Beebe, Kenneth G Nepple, Yousef Zakharia, Robert F Mullins, Miles J Flamme-Wiese, Matthew J Thurtell and Ian C Han

American journal of ophthalmology case reports, Vol.12, pp.55-60

12/2018

DOI: 10.1016/j.ajoc.2018.09.005

PMID: 30229140

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Abstract

To report a case of autoimmune retinopathy and optic neuropathy associated with an enolase-positive renal oncocytoma. A 41-year-old man presented with subacute, painless, bilateral vision loss. On initial examination, visual acuity measured 20/125 OD and 20/1250 OS, and telangiectatic vessels were noted on the optic nerves and in the maculae. Goldmann perimetry showed bilateral, cecocentral scotomas, and electroretinography demonstrated reduced photopic and scotopic signals, concerning for autoimmune retinopathy. Serum testing showed multiple positive anti-optic nerve and anti-retinal antibodies, including to alpha-enolase. Extensive systemic workup was negative except for a large, exophytic, right renal mass. Biopsy was consistent with a benign oncocytoma, and immunohistochemical staining showed diffusely positive alpha-enolase staining. The patient was treated with a five-day course of intravenous methylprednisolone and plasmapheresis with minimal improvement. Surgical excision of the oncocytoma was performed. At 9-months post-operatively, visual acuity had improved to 20/40 OU, with corresponding improvement on visual field and electroretinography testing. To our knowledge, this is the first report of autoimmune retinopathy and optic neuropathy associated with a renal oncocytoma. The case highlights the importance of a thorough systemic workup in cases of suspected autoimmune retinopathy and reminds clinicians that even tumors considered benign can have distal effects on other organs.

Optic neuropathy

Oncocytoma

Autoimmune retinopathy

Details

Title: Subtitle: Autoimmune retinopathy and optic neuropathy associated with enolase-positive renal oncocytoma
Creators: Justine L Cheng - University of Iowa
Johanna D Beebe - University of Iowa
Kenneth G Nepple - University of Iowa
Yousef Zakharia - University of Iowa
Robert F Mullins - University of Iowa
Miles J Flamme-Wiese - University of Iowa
Matthew J Thurtell - University of Iowa
Ian C Han - University of Iowa
Resource Type: Journal article
Publication Details: American journal of ophthalmology case reports, Vol.12, pp.55-60
DOI: 10.1016/j.ajoc.2018.09.005
PMID: 30229140
NLM abbreviation: Am J Ophthalmol Case Rep
ISSN: 2451-9936
eISSN: 2451-9936
Grant note: name: NIH, award: EY025990, EY023279, P30 EY025580, VA RX001786
Language: English
Date published: 12/2018
Academic Unit: Neurology; Hematology, Oncology, and Blood & Marrow Transplantation; Urology; Internal Medicine; Ophthalmology and Visual Sciences
Record Identifier: 9984180938302771

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