{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T17:14:37Z","timestamp":1787764477033,"version":"build-2784847793"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":314,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Central retinal artery occlusion (CRAO) is an ophthalmic emergency characterized by sudden vision loss; it is rarely associated with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Herein, we report a case of a man in his 80s who, experiencing persistent fever, weight loss, and myalgia, received corticosteroid therapy at a local hospital for a presumptive diagnosis of polymyalgia rheumatica. While on this treatment, he suddenly developed vision loss in the left eye; visual acuity was limited to light perception, and fundus examination revealed a cherry-red spot in the macula, consistent with CRAO. The patient was urgently referred and admitted to the rheumatology department of our hospital for evaluation and management of suspected systemic vasculitis underlying CRAO. The presence of persistent fever, elevated inflammatory markers, positive myeloperoxidase-ANCA, interstitial lung disease, purpura, and small-vessel vasculitis confirmed via muscle biopsy led to the diagnosis of microscopic polyangiitis. Given this clinical course and definitive diagnosis, his initial systemic symptoms were considered early manifestations of the underlying microscopic polyangiitis. The patient was treated with methylprednisolone pulse therapy and rituximab, followed by azathioprine; the inflammatory markers improved, and visual acuity recovered to hand motion by discharge. This case highlights that when CRAO occurs alongside systemic symptoms, ANCA-associated vasculitis should be strongly considered as a potential underlying cause. Timely identification of such systemic vasculitis is crucial to enhance the possibility of visual recovery and to reduce complications affecting vital organs beyond the eye.<\/jats:p>","DOI":"10.1093\/mrcr\/rxaf068","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T12:29:42Z","timestamp":1762777782000},"source":"Crossref","is-referenced-by-count":1,"title":["When vision loss signals vasculitis: central retinal artery occlusion leading to microscopic polyangiitis diagnosis\u2014a case report"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1675-1362","authenticated-orcid":false,"given":"Riko","family":"Kamada","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital , Fujisawa, Kanagawa ,","place":["Japan"]},{"name":"Division of Rheumatology, Shonan Kamakura General Hospital , Kamakura, Kanagawa ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1638-5027","authenticated-orcid":false,"given":"Makoto","family":"Hibino","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital , Fujisawa, Kanagawa ,","place":["Japan"]},{"name":"Department of Respiratory Medicine, Shonan Oiso Hospital , Oiso, Kanagawa ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hikari","family":"Higa","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital , Fujisawa, Kanagawa ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigehiro","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital , Fujisawa, Kanagawa ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazunari","family":"Maeda","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital , Fujisawa, Kanagawa ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Kakutani","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Shonan Kamakura General Hospital , Kamakura, Kanagawa ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuru","family":"Yanai","sequence":"additional","affiliation":[{"name":"Department of Pathology, Sapporo Tokushukai Hospital , Sapporo, Hokkaido ,","place":["Japan"]},{"name":"Department of Pathology, Shonan Kamakura General Hospital , Kamakura, Kanagawa ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuri","family":"Kondo","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital , Fujisawa, Kanagawa ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"2025112810272878000_ref1","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.rdc.2010.05.005","article-title":"Ocular manifestations of ANCA-associated vasculitis","volume":"36","author":"Kubal","year":"2010","journal-title":"Rheum Dis Clin N Am"},{"key":"2025112810272878000_ref2","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1007\/s12177-009-9044-4","article-title":"Ocular disease in patients with ANCA-positive vasculitis","volume":"3","author":"Watkins","year":"2009","journal-title":"J Ocul Biol Dis Infor"},{"key":"2025112810272878000_ref3","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.semarthrit.2012.08.003","article-title":"Ophthalmologic manifestations of systemic necrotizing vasculitides at diagnosis: a retrospective study of 1286 patients and review of the literature","volume":"42","author":"Rothschild","year":"2013","journal-title":"Semin Arthritis Rheum"},{"key":"2025112810272878000_ref4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.22336\/rjo.2020.2","article-title":"Eye involvement in ANCA positive vasculitis","volume":"64","author":"Macarie","year":"2020","journal-title":"Rom J Ophthalmol"},{"key":"2025112810272878000_ref5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00417-022-05747-x","article-title":"Management of ocular arterial ischemic diseases: a review","volume":"261","author":"Vilares-Morgado","year":"2023","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"2025112810272878000_ref6","volume-title":"Manual de Condutas Em Oftalmologia","author":"Hofling-Lima","year":"2008"},{"key":"2025112810272878000_ref7","volume-title":"Clinical Ophthalmology: A Systematic Approach","author":"Kanski","year":"2011","edition":"7th"},{"key":"2025112810272878000_ref8","first-page":"372","article-title":"Optic disc pallor after central retinal artery occlusion","volume":"20","author":"Hayreh","year":"2000","journal-title":"Retina"},{"key":"2025112810272878000_ref9","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/WNO.0b013e31814b1f66","article-title":"Thrombolysis for central retinal artery occlusion","volume":"27","author":"Biousse","year":"2007","journal-title":"J Neuroophthalmol"},{"key":"2025112810272878000_ref10","doi-asserted-by":"crossref","first-page":"386","DOI":"10.5935\/0034-7280.20150081","article-title":"Central retinal artery occlusion in patient with microscopic polyangiitis","volume":"74","author":"Domingues","year":"2015","journal-title":"Rev Bras Oftalmol"},{"key":"2025112810272878000_ref11","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1136\/annrheumdis-2021-221796","article-title":"2022 American College of Rheumatology\/European alliance of associations for rheumatology classification criteria for microscopic polyangiitis","volume":"81","author":"Suppiah","year":"2022","journal-title":"Ann Rheum Dis"},{"key":"2025112810272878000_ref12","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/S0161-6420(81)35080-5","article-title":"Retinal arterial obstruction in children and young adults","volume":"88","author":"Brown","year":"1981","journal-title":"Ophthalmology"},{"key":"2025112810272878000_ref13","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1016\/j.ophtha.2014.04.029","article-title":"Nationwide incidence of clinically diagnosed central retinal artery occlusion in Korea, 2008 to 2011","volume":"121","author":"Park","year":"2014","journal-title":"Ophthalmology"},{"key":"2025112810272878000_ref14","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1007\/s10067-015-2921-2","article-title":"Patient-reported outcomes in ANCA-associated vasculitis. A comparison between Birmingham Vasculitis Activity Score and routine assessment of patient index data 3","volume":"35","author":"Annapureddy","year":"2016","journal-title":"Clin Rheumatol"},{"key":"2025112810272878000_ref15","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s11926-019-0835-8","article-title":"Treatment strategies in ANCA-associated vasculitis","volume":"21","author":"Emejuaiwe","year":"2019","journal-title":"Curr Rheumatol Rep"},{"key":"2025112810272878000_ref16","doi-asserted-by":"crossref","first-page":"178","DOI":"10.4103\/0301-4738.112164","article-title":"A case of Churg-Strauss syndrome and central retinal artery occlusion with good visual recovery","volume":"61","author":"Kamata","year":"2013","journal-title":"Indian J Ophthalmol"}],"container-title":["Modern Rheumatology Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/mrcr\/advance-article-pdf\/doi\/10.1093\/mrcr\/rxaf068\/65269186\/rxaf068.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mrcr\/article-pdf\/9\/2\/rxaf068\/65269186\/rxaf068.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mrcr\/article-pdf\/9\/2\/rxaf068\/65269186\/rxaf068.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T15:27:37Z","timestamp":1764343657000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/mrcr\/article\/doi\/10.1093\/mrcr\/rxaf068\/8320488"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":16,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,7,25]]}},"URL":"https:\/\/doi.org\/10.1093\/mrcr\/rxaf068","relation":{},"ISSN":["2472-5625"],"issn-type":[{"value":"2472-5625","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025]]},"published":{"date-parts":[[2025]]},"article-number":"rxaf068"}}