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PURPOSE: To evaluate the association between ocular trauma and activation of ocular toxoplasmosis. METHODS: Retrospective review of 686 patients with ocular toxoplasmosis and its association with trauma to the eye or the head within 1 week of activation. RESULTS: Ten patients with a history of trauma and activation of ocular toxoplasmosis were detected (10/686; 1.45%). Nine patients showed a primary focus of retinitis without a previous scar and one patient had a recurrent form of ocular toxoplasmosis. From these 10 patients, Toxoplasma IgG was positive in eight of them. The median age of the patients was 35.8 years-old (range 17 to 65). CONCLUSIONS: These cases suggest that trauma can be associated with activation of retinal bradyzoite cysts in ocular toxoplasmosis.
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BACKGROUND: Hodgkin lymphoma (HL) is a hematopoietic neoplasm characterized by cancerous Reed-Sternberg cells. In contrast to ophthalmic manifestations by non-HL that are well recognized, there is paucity of the literature as it relates to ophthalmic manifestation by HL. We performed a comprehensive review of published studies (case reports and small case series) to characterize the ophthalmic manifestations of HL. SUMMARY: Thirty patients were identified with ophthalmic manifestation of HL. Thirteen (43%) were male, and 14 (46%) were female (in 3 cases, sex was not specified). The median age at ophthalmic presentation was 27 years. Diagnosis of HL was made after ophthalmic manifestation in 10 (33%) cases, whereas 11 (36%) cases had a prior diagnosis of HL. Ophthalmic manifestations can be classified into 3 main groups; direct infiltration, inflammatory reaction, and paraneoplastic process. Seven cases had infiltration of the optic nerve. Uveal inflammatory reaction was reported in 21 cases. The presence of intraocular Reed-Sternberg cells had been confirmed in 1 case with granulomatous uveitis. Conjunctival and corneal reaction was seen in 3 cases. HL was in stage 2 or higher, with only 1 case with stage 1A (12 cases HL stage not specified). Seven cases (22%) died of HD, all were diagnosed with advanced lymphoma, and none was treated with chemotherapy. KEY MESSAGE: Ocular involvement in HL is extremely rare. A few cases of histopathologically confirmed optic nerve/tract infiltration are within the spectrum of CNS involvement by HL. Inflammatory uveitis is the most common ophthalmic association of HL. In the presence of prior known diagnosis of HL, restaging should be considered to exclude recurrence. Toxicity or adverse reaction to drugs used to treat HL may also contribute to ophthalmic involvement.
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La poliangeítis con granulomatosis (GPA) es una enfermedad inflamatoria sistémica; los hallazgos histopatológicos incluyen necrosis tisular, formación de granulomas y vasculitis predominantemente devasos de pequeño y mediano calibre. Se caracteriza por la presencia en plasma de anticuerpos anti-citoplasma de neutrófilo dirigidos contra la proteinasa 3 (PR3-ANCA). La GPA comúnmente afecta la vía aérea superior, los pulmones y los riñones. El compromiso oftalmológico es una importante causa de morbilidad, ocurriendo aproximadamente en la mitad de los pacientes. La escleritis necrotizante (EN) es una manifestación infrecuente y grave de la GPA. Las complicaciones de la EN son la perforación ocular y pérdida de la visión. El tratamiento de inducción consiste en esteroides e inmunosupresores (ciclofosfamida o rituximab). El objetivo de este trabajo es describir 3 casos de GPA con EN como manifestación clínica rara y dominante.
Granulomatosis with polyangiitis (GPA) is a systemic inflammatory disease; histopathologic features often include necrosis, granulomaformation, and vasculitis of small-to-medium size vessels. Its characterizedby the presence of anti-neutrophil cytoplasm directedagainst proteinase 3 (PR3-ANCA). The GPA commonly affects the upperairways, lungs and kidneys. Ophthalmological involvement is animportant cause of morbidity in GPA, occurring in approximately inone-half of patients. Necrotizing scleritis is a rare and severe formof ocular manifestation in GPA. Complications are ocular perforationand loss of vision. Induction therapy involves steroids and immunosuppressants (cyclophosphamide or rituximab). The aim of this studyis to describe 3 cases of GPA with necrotizing scleritis as a rare anddominant clinical manifestation.
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Humanos , Granulomatose com Poliangiite , EscleriteRESUMO
The diagnosis of ocular toxoplasmosis is mainly clinical, based in the presence of focal necrotizing retinochoroiditis often associated with a preexistent chorioretinal scar, and variable involvement of the vitreous, retinal blood vessels, optic nerve, and anterior segment of the eye. Recognition of this clinical spectrum of toxoplasmic retinochoroiditis is crucial, but other infectious, noninfectious, and neoplastic entities should also be considered in the differential diagnosis. Investigations such as serological tests, polymerase chain reaction of ocular fluids, and assessment of intraocular antibody synthesis are helpful in uncertain cases. This article provides an overview of the differential diagnosis of ocular toxoplasmosis, focusing on the most important entities to be considered and emphasizing distinctive features of each one of them in the clinical setting. Ocular toxoplasmosis has multiple clinical manifestations, which partially overlap with those of other entities and these should be carefully considered when making the differential diagnosis, particularly in less typical cases.
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Toxoplasmose Ocular/diagnóstico , Coriorretinite/congênito , Coriorretinite/diagnóstico , Coriorretinite/parasitologia , Diagnóstico Diferencial , Endoftalmite/diagnóstico , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Fúngicas/diagnóstico , Neoplasias Oculares/diagnóstico , Herpes Simples , Herpes Zoster , Humanos , Linfoma/diagnóstico , Macula Lutea/patologia , Doenças Retinianas/diagnóstico , Doenças Retinianas/virologia , Síndrome de Necrose Retiniana Aguda/diagnóstico , Síndrome de Necrose Retiniana Aguda/parasitologia , Neoplasias da Retina/diagnóstico , Retinite/parasitologia , Sífilis/diagnóstico , Tuberculose Ocular , Uveíte Posterior/diagnóstico , Uveíte Posterior/microbiologia , Corpo VítreoRESUMO
Un paciente de 38 años de edad fue derivado con diagnóstico de leishmaniasis mucocutánea por un proceso destructivo de la nariz y los senos paranasales, con severo compromiso oftalmológico. Este trabajo discute los diagnósticos diferenciales de las lesiones destructivas de la línea media. El estudio de estas lesiones es dificultoso, pero debe efectuarse con una aproximación sistemática y múltiples técnicas diagnósticas. El diagnóstico final fue de Granulomatosisde Wegener.
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Granulomatose com Poliangiite , LeishmanioseRESUMO
PURPOSE: To describe characteristics of intraocular inflammation in eyes with active ocular toxoplasmosis and to identify relationships between signs of inflammation, complications (including elevated intraocular pressure [IOP]), other disease features, and host characteristics. DESIGN: Multicenter, retrospective, cross-sectional study. METHODS: We reviewed the medical records of 210 patients with toxoplasmic retinochoroiditis at seven international sites (North America, South America, and Europe) for information from the first examination at each site during which patients had active retinal lesions. Signs of inflammation included anterior chamber (AC) cells and flare and vitreous humor cells and haze. Retinal lesion characteristics included size (< or =1 disc area [DA] or >1 DA) and presence or absence of macular involvement. RESULTS: AC cells and flare were related to vitreous inflammatory reactions (P < or = .041). One or more signs of increased inflammation were related to the following factors: older patient age, larger retinal lesions, and extramacular location. In 30% of involved eyes, there was evidence of elevated IOP (despite use of glaucoma medications by some patients); other complications were uncommon. IOP of more than 21 mm Hg was associated with both increased AC cells and elevated flare (both P < or = .001) and with macular involvement (P = .009). Inflammation seemed to be more severe among patients in Brazil than among those at other sites. CONCLUSIONS: There is substantial variation between patients in the severity of intraocular inflammation associated with ocular toxoplasmosis, attributable to multiple host- and disease-related factors. Results suggest that disease characteristics also vary in different areas of the world. Elevated IOP at initial examination reflects the severity of inflammation.
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Coriorretinite/diagnóstico , Toxoplasmose Ocular/diagnóstico , Adolescente , Adulto , Idoso , Câmara Anterior/imunologia , Câmara Anterior/patologia , Antiprotozoários/uso terapêutico , Criança , Coriorretinite/tratamento farmacológico , Estudos Transversais , Quimioterapia Combinada , Feminino , Humanos , Imunossupressores/uso terapêutico , Inflamação/diagnóstico , Inflamação/tratamento farmacológico , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Estudos Retrospectivos , Toxoplasmose Ocular/tratamento farmacológico , Corpo Vítreo/imunologia , Corpo Vítreo/patologia , Adulto JovemRESUMO
PURPOSE OF REVIEW: The purpose of this review is to update the latest information on a long-recognized infectious disease, ocular toxoplasmosis. RECENT FINDINGS: Topics include how the disease is acquired, how to make a clinical diagnosis, and what laboratory tests to order when the diagnosis is not clear. New insights into the genetic make-up of the parasite and new treatment alternatives are discussed. SUMMARY: Recent findings are updated on the epidemiologic status of the disease, methods for correct diagnosis of unusual presentations, and alternative therapies.
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Antiprotozoários/uso terapêutico , Toxoplasmose Ocular , Animais , DNA de Protozoário/análise , Diagnóstico Diferencial , Humanos , Incidência , Prognóstico , Toxoplasma/genética , Toxoplasmose Ocular/diagnóstico , Toxoplasmose Ocular/tratamento farmacológico , Toxoplasmose Ocular/epidemiologiaRESUMO
PURPOSE: To report a case of subretinal abscess due to Nocardia farcinica resistant to trimethoprim-sulfamethoxazole in a patient with systemic lupus erythematosus on immunosuppressive therapy. DESIGN: Observational case report. METHODS: We retrospectively studied the medical record of a patient with nocardiosis. RESULTS: The microorganism disseminated from the lungs (pneumonia) to the eye and brain. The ocular lesion appeared to be a yellowish, lobulated subretinal abscess with irregular surface and superficial retinal hemorrhages. As it was not responding to empiric therapy for nocardia, pars plana vitrectomy and aspiration of the subretinal material was performed to confirm the etiology. CONCLUSION: In an immunocompromised patient with pulmonary involvement and a subretinal abscess with a characteristic aspect, one should consider nocardia as a possible etiology taking into account its possible antibiotic resistances.
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Abscesso/microbiologia , Infecções Oculares Bacterianas/microbiologia , Lúpus Eritematoso Sistêmico/complicações , Nocardiose/microbiologia , Nocardia/isolamento & purificação , Doenças Retinianas/microbiologia , Resistência a Trimetoprima , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Adulto , Antibacterianos/uso terapêutico , Ciprofloxacina/uso terapêutico , Terapia Combinada , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/cirurgia , Feminino , Humanos , Nocardia/efeitos dos fármacos , Nocardiose/tratamento farmacológico , Nocardiose/cirurgia , Doenças Retinianas/tratamento farmacológico , Doenças Retinianas/cirurgia , Estudos Retrospectivos , VitrectomiaRESUMO
El objetivo del trabajo es reportar el caso de una paciente de 19 años con diabetes mellitus tipo I que presenta una papilopatía diabética bilateral con mejoría espontánea de su cuadro
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Adolescente , Humanos , Feminino , Disco Óptico/patologia , Diabetes Mellitus Tipo 1/terapia , Papiledema , Retinopatia Diabética/patologiaRESUMO
El objetivo del trabajo es reportar el caso de una paciente de 19 años con diabetes mellitus tipo I que presenta una papilopatía diabética bilateral con mejoría espontánea de su cuadro