RESUMEN
An 85-year-old, immunocompetent man was referred to the authors due to the presence of an enlarging, pigmented mass of the conjunctiva concerning for a conjunctival melanoma. Wide excision of the mass revealed a pigmented or "dematiaceous" fungus. He was treated with topical natamycin, and the lesion healed well without any evidence of recurrence. Dematiaceous fungi should be considered in the differential for pigmented conjunctival lesions.
Asunto(s)
Enfermedades de la Conjuntiva/diagnóstico , Neoplasias de la Conjuntiva/diagnóstico , Exophiala/aislamiento & purificación , Infecciones Fúngicas del Ojo/diagnóstico , Melanoma/diagnóstico , Feohifomicosis/diagnóstico , Anciano de 80 o más Años , Terapia Combinada , Enfermedades de la Conjuntiva/terapia , Crioterapia , Diagnóstico Diferencial , Infecciones Fúngicas del Ojo/terapia , Humanos , Masculino , Procedimientos Quirúrgicos Oftalmológicos , Feohifomicosis/terapiaRESUMEN
A patient with systemic cytomegalovirus (CMV), including chorioretinitis, received localized and systemic ganciclovir, systemic cidofovir analog, and localized foscarnet. Mutations conferring ganciclovir and cidofovir resistance were detected in CMV from the aqueous fluid but not in CMV from plasma. Quantifying CMV from aqueous fluid was valuable for monitoring the clinical response and predicting resistance.
Asunto(s)
Antivirales/administración & dosificación , Retinitis por Citomegalovirus/virología , Citomegalovirus/efectos de los fármacos , Citomegalovirus/aislamiento & purificación , Farmacorresistencia Viral , Ganciclovir/administración & dosificación , Plasma/virología , Adulto , Antivirales/farmacología , Cidofovir , Citomegalovirus/genética , Citosina/administración & dosificación , Citosina/análogos & derivados , ADN Viral/genética , Ojo/virología , Femenino , Foscarnet/administración & dosificación , Ganciclovir/farmacología , Humanos , Organofosfonatos/administración & dosificación , Análisis de Secuencia de ADNRESUMEN
An 11-year-old boy presented with progressive right-sided proptosis and an orbital mass on neuroimaging. Incisional biopsy revealed an epithelioid hemangioma. The patient underwent an orbitotomy with subtotal excision of the mass. However, the tumor recurred and progressed to the cavernous sinus, despite oral steroids, tacrolimus, and a second subtotal excision. Because of encouraging results reported with beta-blockers in the treatment of pediatric capillary hemangiomas, the patient was subsequently started on oral propranolol, 2 mg/kg/day, with discontinuation of steroids and tacrolimus. A rapid and impressive interval decrease in tumor size was observed, with improvement in proptosis and exposure keratopathy. The patient remains without recurrence approximately 9 months after initiation of propranolol. Our results suggest that oral propranolol may be a potential alternative therapy when complete excision of an epithelioid hemangioma is not practical.