A 32 year-old female with a past medical history of several years of intranasal cocaine usage, bipolar disorder type 1 and no ophthalmic history presented with vision loss in the right eye for 2 weeks..
A 32 year-old female with a past medical history of several years of intranasal cocaine usage, bipolar disorder type 1 and no ophthalmic history presented with vision loss in the right eye for 2 weeks duration. Visual acuity in the right eye was count fingers at 1 foot. Patient had a pronounced relative afferent pupillary defect, deficiency in abduction of the right eye, and mild disc edema. Imaging showed evidence of severe sinusitis. She was admitted for treatment of sinusitis with antibiotics. Mucormycosis was ruled out. Vision decreased to no light perception on day 1 of admission. She was found to have biopsy-proven granulomatosis with polyangiitis. She was started on immunosuppression. She has been lost to follow-up.