Clinical, electrophysiologic and serologic evidence of cancer associated retinopathy preceding a diagnosis of breast cancer

We report the case of a woman in her 50s who presented headaches, blurred vision, diplopia and loss of peripheral vision. She was treated for normal tension glaucoma based on optic nerve cupping prior to the development of diplopia. Records demonstrated visual field constriction over 4 months despit...

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Bibliographic Details
Published inBMJ case reports Vol. 17; no. 4; p. e257911
Main Authors Ball, Jordan E, Smith, Brian M, Zocchi, Kent, Doyle, Jennifer
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 25.04.2024
Subjects
Antibodies
Antigens
Automation
Breast cancer
Breast Neoplasms - complications
Cancer therapies
Case reports
Diplopia
Electroretinography
Family medical history
Female
Glaucoma
Humans
Lumpectomy
Mammography
Medical diagnosis
Medical screening
Middle Aged
Optics
Paraneoplastic Syndromes, Ocular - diagnosis
Patients
Primary care
Retinal Diseases - diagnosis
Retinal Diseases - etiology
Tomography
Vision Disorders - diagnosis
Vision Disorders - etiology
Visual Acuity
Visual Fields
Retina
Breast cancer
Ophthalmology
Neuroopthalmology
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Summary:We report the case of a woman in her 50s who presented headaches, blurred vision, diplopia and loss of peripheral vision. She was treated for normal tension glaucoma based on optic nerve cupping prior to the development of diplopia. Records demonstrated visual field constriction over 4 months despite well-controlled intraocular pressures. Examination revealed decreased visual acuity and visual field constriction. The multifocal electroretinogram was abnormal. After a thorough review of her medical and family history, a concern for cancer-associated retinopathy developed. Blood samples were positive for antiretinal antibodies against 23 kDA and 46 kDA proteins. Cancer screening was recommended as the aetiology for retinopathy was unknown and revealed a left breast lump. Following lumpectomy with adjuvant chemoradiation, her visual acuity normalised and visual field defects completely resolved. This case serves to provide an example that distant systemic symptoms may be a manifestation of the underlying malignancy and the importance of clinical suspicion with prompt evaluation.
Bibliography:ObjectType-Case Study-2
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ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2023-257911