RESUMEN
A patient who presented with severely decreased bilateral vision was found to have syphilis and neurosyphilis that responded well to a 14-day course of penicillin and prednisone. The patient tested positive for HIV, which can alter the natural course of syphilis, often making the diagnosis and treatment difficult. Conventional therapy for syphilis may not be effective in patients with HIV. Any patient with syphilis who is in a high-risk group should be tested for HIV; conversely, any patient with HIV should be tested for syphilis if signs or suspicions exist.
Asunto(s)
Oftalmopatías/complicaciones , Infecciones por VIH/complicaciones , Neurosífilis/complicaciones , Neurosífilis/diagnóstico , Adulto , Angiografía , Quimioterapia Combinada , Oftalmopatías/diagnóstico , Oftalmopatías/tratamiento farmacológico , Oftalmopatías/microbiología , Humanos , Masculino , Neurosífilis/tratamiento farmacológico , Penicilinas/administración & dosificación , Penicilinas/uso terapéutico , Prednisona/administración & dosificación , Prednisona/uso terapéutico , Serodiagnóstico de la Sífilis , Zidovudina/administración & dosificación , Zidovudina/uso terapéuticoRESUMEN
Epidemiologic studies have demonstrated a strong association between human immunodeficiency virus (HIV) and syphilitic infection. Recent reports have suggested that concurrent HIV and luetic infection may lead to an accelerated and more fulminant course of syphilis. Specifically, neurosyphilis is encountered much earlier in such patients. We report two cases in which both neurosyphilis and ocular syphilis were present in HIV sero-positive patients. A review of the literature reveals that 11 of 13 (85%) HIV-infected patients with ophthalmic syphilis also had neurosyphilis. In patients who present with signs of ocular inflammation and pose a diagnostic dilemma, syphilis and possible concurrent HIV infection merit strong consideration. We wish to emphasize that patients should be evaluated for the presence of neurosyphilis if co-infection exists. Ophthalmologists should be aware that neuro-ophthalmic lues may prove to be the presenting feature of infection with HIV.
Asunto(s)
Infecciones Bacterianas del Ojo/complicaciones , Infecciones por VIH/complicaciones , Neurosífilis/complicaciones , Sífilis/complicaciones , Adulto , Amoxicilina/uso terapéutico , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Fondo de Ojo , Seropositividad para VIH/diagnóstico , Humanos , Masculino , Neurosífilis/diagnóstico , Neurosífilis/tratamiento farmacológico , Penicilina G/uso terapéutico , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Serodiagnóstico de la Sífilis , Agudeza VisualRESUMEN
The acute retinal necrosis (ARN) syndrome has been recently linked to intraocular infection with one or more members of the herpesvirus family. The authors report two cases of ARN following herpes zoster skin eruptions, and one case following ipsilateral facial nerve palsy (Ramsay Hunt syndrome). Evaluation of serial serum antibody titers against cytomegalovirus (CMV), herpes simplex virus (HSV) (types 1 and 2), and varicella zoster (VZ) virus revealed diagnostic changes for VZ virus alone following the retinitis. Immune precipitation of radiolabeled VZ proteins by these sera followed by gel fractionation yielded radioimmune precipitation profiles characteristic of a recent zoster reactivation. These cases further implicate a central role for VZ virus infection in the etiology of the ARN syndrome.
Asunto(s)
Dermatitis/etiología , Herpes Zóster , Enfermedades de la Retina/etiología , Enfermedad Aguda , Adulto , Dermatitis/complicaciones , Femenino , Herpes Zóster/inmunología , Herpes Zóster/patología , Humanos , Masculino , Persona de Mediana Edad , Necrosis , Enfermedades de la Retina/patología , Serología , SíndromeRESUMEN
Carbonic anhydrase inhibitors used in the treatment of glaucoma are rarely associated with blood dyscrasias. Several case reports of aplastic anemia with use of acetazolamide, and two cases with use of methazolamide, have appeared in the literature. This report documents two cases of aplastic anemia, at least one of which was almost certainly induced by the use of methazolamide, one case of agranulocytosis, and two cases of neutropenia related to the use of methazolamide. In each case several weeks to months elapsed between initiation of therapy and onset of reaction. This suggests that changes in patients' general medical condition should be continually monitored when using these drugs.
Asunto(s)
Glaucoma/tratamiento farmacológico , Enfermedades Hematológicas/inducido químicamente , Metazolamida/efectos adversos , Tiadiazoles/efectos adversos , Adolescente , Adulto , Anciano , Agranulocitosis/inducido químicamente , Anemia Aplásica/inducido químicamente , Femenino , Humanos , Masculino , Metazolamida/uso terapéutico , Neutropenia/inducido químicamenteRESUMEN
Carbonic anhydrase inhibitors used in the treatment of glaucoma, seizure disorders, and hypertension are rarely associated with blood dyscrasias. Several case reports of aplastic anemia with use of acetazolamide, and two cases with use of methazolamide, have appeared in the literature. This article describes two cases of aplastic anemia, at least one of which was almost certainly induced by the use of methazolamide, and one case of agranulocytosis related to the use of methazolamide.