Neuroretinitis with abnormal brain imaging in Ask-Upmark kidney: A novel case report

• Published in: Journal of pediatric neurosciences Vol. 9; no. 2; pp. 172 - 174
• Main Authors: Kasundra, Gaurav M, Sood, Isha, Prakash, Sanjay, Mehta, Dhruv P
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.05.2014; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd
• Subjects: Blood pressure; Care and treatment; Case Report; Case studies; Complications and side effects; Diagnosis; Hypertension; Kidneys; Magnetic resonance imaging; Multiple sclerosis; NMR; Nuclear magnetic resonance; Retinal diseases; India; Hypertension; Ask-Upmark kidney; neuroretinitis; multiple sclerosis; macular star
• ISSN: 1817-1745; 1998-3948
• DOI: 10.4103/1817-1745.139347

We report a 13-year-old female patient having vertigo and visual blurring since 2 weeks with blood pressure being 180/106 mmHg. Fundus examination showed optic disc edema with macular star. After ruling out infective causes, idiopathic neuroretinitis was diagnosed. Her brain magnetic resonance imaging (MRI) scan revealed three periventricular morphologically multiple sclerosis (MS)-like white matter lesions. Renal ultrasound and renal arteriogram showed a shrunken left kidney, small non-stenotic left renal artery and reduced vessels in upper pole of left kidney, consistent with Ask-Upmark kidney (AUK). Her symptoms improved with antihypertensive drugs. Follow-up MRI at 1 year revealed no interval change, while fundus had normalized. Neuroretinitis typically has normal brain MRI and rules out MS. However, our patient having AUK-induced hypertension had neuroretinitis and MS-like brain lesions and did not fulfill diagnostic criteria for MS. Thus we postulate that MS-like lesions can be part of neuroretinitis, especially in hypertensive patients.