Pituitary adenomas with ocular manifestations: incidence of cases and clinical findings 1946–1984

Abstract Background Cat scratch disease (CSD) is a systemic illness caused by the gram-negative bacillus, Bartonella henselea, which can occasionally involve the ocular structures. The objective of this study is to evaluate the various clinical presentations of ocular bartonellosis at our institution. A retrospective review of the clinical records of 13 patients (23 eyes) with ocular manifestations of Bartonella infections over a 3-year period between January 2016 to December 2018 was undertaken at our institution. Results The diagnosis was made based on clinical findings and in addition, with the support of the evidence of Bartonella hensalae IgG and/or IgM. Small retinal white lesions were the most common ocular findings in this series of patients (82.6% of eyes, 76.9% of patients). Neuroretinitis was the second most common finding (47.8% of eyes, 69.2% of patients), followed by exudative retinal detachment involving the macula (34.8% of eyes, 53.8% of patients) and Parinaud’s oculoglandular syndrome (17.4% of eyes, 23.1% of patients). Other findings like isolated optic disc oedema without macular star (8.7% of eyes, 15.4% of patients) and vitritis (4.3% of eyes, 7.7% of patients) were also observed. Ten patients (76.9%) had bilateral ocular involvement. Most of the patients were young, immunocompetent and had systemic symptoms like fever prior to their ocular symptoms. The visual acuity (VA) at initial presentation ranged from 6/6 to hand movement (mean, 6/20), and at final visit 6/6 to 6/60, (mean, 6/9). 91.7% of patients were treated with antibiotics. Only 2 patients received oral corticosteroids together with antibiotics due to very poor vision on presentation. The visual prognosis of ocular bartonellosis is generally good with 16 (88.9%) of 23 eyes having VA of 6/12 or better at final follow-up visit. Conclusion Small foci of retinal white lesions were the most common manifestation of ocular bartonellosis in this series, followed by neuroretinitis, though an array of other ocular findings may also occur. Therefore, we should consider bartonella infection as a possible differential diagnosis in those patients.

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Correlation Between Tumor Vascularity and Clinical Findings in Patients with Pituitary Adenomas

Endocrine Pathology ◽

10.1385/ep:15:2:131 ◽

2004 ◽

Vol 15 (2) ◽

pp. 131-140 ◽

Cited By ~ 25

Author(s):

Koji Takada ◽

Shozo Yamada ◽

Akira Teramoto

Keyword(s):

Pituitary Adenomas ◽

Clinical Findings ◽

Tumor Vascularity

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A rare case of Panophthalmitis due to cobra bite

European Journal of Ophthalmology ◽

10.1177/11206721211049704 ◽

2021 ◽

pp. 112067212110497

Author(s):

Suganeswari Ganesan ◽

Aditi Ashok Kumar Agarwal ◽

Krishnakumar Subramanian

Keyword(s):

Snake Venom ◽

Rare Case ◽

Sudden Onset ◽

Clinical Findings ◽

Snake Bite ◽

Venom Toxin ◽

Ocular Manifestations ◽

Male Farmer ◽

Snake Venom Toxin ◽

Indirect Injury

Purpose Ocular manifestations of snake bite are rare, ranging from direct injury to the eye from snake venom or indirect injury due to antivenom. We report a rare case of cobra bite causing panophthalmitis due to indirect injury as a result of snake venom toxin related tissue necrosis and susceptibility to secondary infections. Methods Observational case report. External photographs, slit lamp photos, ultrasonography of the eye and histopathology of the eviscerated eye were used to characterize and describe the clinical findings. Thirty-nine-years-old male farmer presented with history of cobra snake bite on his right index finger and developed right eye sudden onset pain and redness 3 days later. On examination, features were suggestive of panophthalmitis and the eye had to be eviscerated with scleral excision. Conclusion It is important for ophthalmologist to be aware of such grave consequences of snake bite to be prepared for the emergency management of such cases.

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Ophthalmic Manifestations of Neurologic, Rheumatologic, and Infectious Diseases in the Context of the novel Coronavirus Disease 2019 Pandemic: A Case Series

Journal of Medical Clinical Case Reports ◽

10.47485/2767-5416.1023 ◽

2021 ◽

Keyword(s):

Infectious Diseases ◽

Clinical Manifestations ◽

Case Series ◽

Clinical Findings ◽

The Novel ◽

Altered Level ◽

Multiple Systems ◽

Ocular Manifestations ◽

Ophthalmic Manifestations ◽

Novel Coronavirus

The novel Coronavirus Disease 2019 (COVID-19) is known to present with a broad range of clinical manifestations. While symptoms such as fever, cough, dyspnea, myalgias, diarrhea, anosmia, and ageusia predominate, less common manifestations involving multiple systems have also been described. Some reported ocular manifestations include symptoms associated with keratoconjunctivitis, such as chemosis, ocular pain, photophobia, dry eye and tearing [1]. Neurological symptoms in addition to smell and taste dysfunction have been commonly described as well, and include headache, ataxia, dizziness, altered level of consciousness, and stroke [2]. Whether these neuro-ophthalmologic findings reflect direct involvement of these systems or a more generalized response to SARS-CoV-2 infection remains uncertain. Many other neurologic, rheumatologic, and infectious diseases also present with similar clinical findings as those described in COVID-19, further complicating the diagnostic picture. In this case series, we examine several patients presenting with unusual neuro-ophthalmological manifestations and discuss similarities of these findings with those seen in SARS-CoV-2 infection, and review current literature describing possible mechanisms underlying similar findings in patients with confirmed COVID-19.

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Feline Pituitary Adenomas: Correlation of Histologic and Immunohistochemical Characteristics With Clinical Findings and Case Outcome

Veterinary Pathology ◽

10.1177/0300985820978309 ◽

2020 ◽

pp. 030098582097830

Author(s):

Margaret A. Miller ◽

Stacey L. Piotrowski ◽

Taryn A. Donovan ◽

J. Catharine Scott-Moncrieff ◽

Tina J. Owen ◽

...

Keyword(s):

Diabetes Mellitus ◽

Survival Time ◽

Pituitary Adenomas ◽

Periodic Acid ◽

Thyroid Stimulating Hormone ◽

Clinical Findings ◽

Proliferation Index ◽

Ki 67 ◽

Periodic Acid Schiff ◽

Study Results

Pituitary glands from 141 feline autopsy cases were reviewed histologically. Adenoma and hyperplasia were the most common lesions at 13 cases each. Pituitary adenoma was more likely than hyperplasia to be associated with clinical evidence of endocrinopathy or an intracranial mass ( P < .001). A histochemical and immunohistochemical panel was applied to 44 autopsy- or hypophysectomy-derived pituitary adenomas in 43 cats from 2 diagnostic laboratories. Adenomas were differentiated from hyperplasia by the presence of disrupted reticulin fibers. One cat had a double (somatotroph and melanotroph) adenoma. Twenty somatotroph adenomas consisted of periodic acid-Schiff (PAS)-negative acidophils that expressed growth hormone; 16/20 had hypersomatotropism; 17/20 had diabetes mellitus. Eleven melanotroph adenomas consisted of PAS-positive basophils or chromophobes that expressed melanocyte-stimulating and adrenocorticotrophic hormones; 5/11 had hypercortisolism; 6/11 had diabetes mellitus. Eleven gonadotroph adenomas consisted of PAS-negative chromophobes that expressed follicle-stimulating and/or luteinizing hormones. Two thyrotroph adenomas consisted of PAS-negative basophils or chromophobes that expressed thyroid-stimulating hormone. Pituitary-dependent disease was not recognized in cats with gonadotroph or thyrotroph adenomas. The Ki-67 proliferation index in hypophysectomy specimens was lower in somatotroph than in melanotroph adenomas. Fourteen cats with hypophysectomy-treated somatotroph or melanotroph adenoma had an 899-day median survival time versus 173 days in 17 nonsurgical cases. After adjusting for age, adenoma size and type, hypophysectomized cats had an overall better survival time than nonsurgical cases ( P = .029). The study results underscore the value of hypophysectomy and trophic hormone immunohistochemistry in the treatment and classification of feline pituitary adenomas.

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Neurological findings in early syphilis: a comparison between HIV positive and negative patients

Neurology International ◽

10.4081/ni.2013.e19 ◽

2013 ◽

Vol 5 (4) ◽

pp. 19 ◽

Cited By ~ 6

Author(s):

Alejandra González-Duarte ◽

Zaira Medina López

Keyword(s):

Venereal Disease ◽

Age At Onset ◽

Disease Onset ◽

Clinical Findings ◽

Hiv Positive ◽

Ocular Involvement ◽

Early Syphilis ◽

Ocular Manifestations ◽

Csf Pleocytosis ◽

Hiv Negative

After a decade of steady decline, syphilis has reemerged within the past few years and it is seeping back into the HIV negative population. We describe herein 16 consecutive cases of neurosyphilis and compare its clinical characteristics. Of the 16 patients, 14 (87%) were men. Mean age at onset was 43 years old (range: 23-82). Twelve patients (75%) were HIV positive; stage was B2 in 2 patients, B3 and C2 in one patient each, and C3 in 8 patients. The clinical presentation was meningitis in 6 (40%), stroke in 3 (18%), ocular manifestations in 4 (27%), and psychiatric manifestations in 2 (13%) cases. Five additional patients had ocular involvement after a formal ophthalmologic examination. High venereal disease research laboratory test (VDRL) titers in serum and cerebrospinal fluid (CSF) were found. Patients in C3 stage of HIV had less CSF pleocytosis (<5 cells/mm3) than patients in earlier stages (P=0.018). Disease onset was earlier in patients older than 50 years old with HIV (P=0.049). We found that meningitis, ocular manifestations and stroke were the most common clinical findings in early syphilis. Moreover, stroke included the carotid and cerebrobasilar vascular territories. CSF VDRL continues to be a crucial test in all idiopathic cases of meningitis, stroke and uveitis, regardless of the HIV status or CSF pleocytosis. Except for less pleocytosis, there were no important differences between HIV positive and HIV negative patients.

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Progressive retinal vessel malformation in a premature infant with Sturge-Weber syndrome: a case report and a literature review of ocular manifestations in Sturge-Weber syndrome

BMC Ophthalmology ◽

10.1186/s12886-021-01815-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhengping Hu ◽

Jian Cao ◽

Eun Young Choi ◽

Yun Li

Keyword(s):

Retinopathy Of Prematurity ◽

Retinal Vessel ◽

Male Infant ◽

Clinical Findings ◽

Choroidal Hemangioma ◽

Ocular Manifestations ◽

Weber Syndrome ◽

Postmenstrual Age ◽

Sturge Weber Syndrome ◽

Endothelial Growth Factor

Abstract Background Sturge-Weber syndrome is a disorder marked by a distinctive facial capillary malformation, neurological abnormalities, and ocular abnormalities such as glaucoma and choroidal hemangioma. Case presentation We report a case of progressively formed retinal vessel malformation in a premature male infant with Sturge-Weber syndrome and retinopathy of prematurity, after treatment with intravitreal anti-vascular endothelial growth factor (VEGF). The baby was born at 30 weeks gestation with a nevus flammeus involving his left eyelids and maxillary area. On postmenstrual age week 39, he received intravitreal anti-VEGF. Diffuse choroidal hemangioma became evident at 40 weeks, with the classic “tomato catsup fundus” appearance. These clinical findings characterized Sturge-weber syndrome. He presented with posterior retinal vessel tortuosity and vein-to-vein anastomoses at 44 weeks. Conclusion This is a rare case of documented progression of retinal vessel malformations in a patient with Sturge-Weber syndrome and retinopathy of prematurity.

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Uveitis associated with Immunodeficiency and Drugs; Clinical Findings, Diagnosis, and Treatment

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0230 ◽

2020 ◽

pp. 277-283

Keyword(s):

Anterior Uveitis ◽

Highly Active Antiretroviral Therapy ◽

Rare Event ◽

Clinical Findings ◽

Diagnosis And Treatment ◽

Immune Recovery ◽

Drug Induced ◽

Cmv Retinitis ◽

Ocular Manifestations ◽

Highly Active

Immüne recovery uveitis (IRU) is the most common form of immune reconstitution inflammatory syndrome in human immunodeficiency virus (HIV) infected patients with cytomegalovirus (CMV) retinitis who are receiving highly active antiretroviral therapy (HAART) therapy. In patients with CMV retinitis in the HAART era, immune recovery may be associated with a greater number of inflammatory complications, including vitritis, macular edema, epiretinal membrane formation, papillitis, and iris synechiae. Given the range of ocular manifestations of HIV, routine ocular examinations and screening carefully for visual loss are recommended in patients with CD4 counts <50 cells/μL. With the increasing longevity of these patients due to the use of HAART, treatment of IRU may become an issue in the future. Uveitis has been associated with a number of systemic, intravitreal, and topical medications, and may also occur after vaccination and the use of other substances. However, drug-induced uveitis is a relatively rare event. Only a few drugs have been proven to cause uveitis, whereas many others may not represent a direct cause-and-effect relationship. Anterior uveitis is the most common clinical presentation and therefore, patients with new-onset anterior uveitis should be asked whether they have recently started any new medications. These patients need to undergo the same diagnostic protocol followed for any uveitis case. Drug-induced uveitis is almost always reversible within weeks of cessation of the medication and the institution of topical treatment of the inflammation. The clinical findings, diagnosis, and treatment of IRU and drug-induced uveitis are presented in this current study

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Immune Recovery Uveitis: Pathogenesis, Clinical Symptoms, and Treatment

Mediators of Inflammation ◽

10.1155/2014/971417 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 31

Author(s):

Beata Urban ◽

Alina Bakunowicz-Łazarczyk ◽

Marta Michalczuk

Keyword(s):

Highly Active Antiretroviral Therapy ◽

Visual Loss ◽

Clinical Symptoms ◽

Clinical Findings ◽

Immune Recovery ◽

Cd4 Counts ◽

Immune Recovery Uveitis ◽

Ocular Manifestations ◽

Highly Active ◽

Inflammatory Syndrome

IRU is the most common form of immune reconstitution inflammatory syndrome in HIV-infected patients with cytomegalovirus retinitis who are receiving highly active antiretroviral therapy (HAART). Among patients with CMV in the HAART era, immune recovery may be associated with a greater number of inflammatory complications, including macular edema and epiretinal membrane formation. Given the range of ocular manifestations of HIV, routine ocular examinations and screening for visual loss are recommended in patients with CD4 counts <50 cells/μL. With the increasing longevity of these patients due to the use of HAART, treatment of IRU may become an issue in the future. The aim of this paper is to review the current literature concerning immune recovery uveitis. The definition, epidemiology, pathophysiology, clinical findings, complications, diagnosis, and treatment are presented.

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Borrelia, Bartonella and Rickettsia Related Uveitis; Diagnosis and Management

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0180 ◽

2019 ◽

pp. 300-304

Keyword(s):

Systemic Disease ◽

Clinical Findings ◽

Diagnosis And Management ◽

Arthropod Vectors ◽

Ocular Manifestations ◽

Prompt Diagnosis

Rickettsia and Borrelia are microorganisms that are transmitted to humans through a bite of arthropod vectors such as ticks, lice, fleas. Bartonella is often transmitted to humans by cat scratches or bites and causing systemic disease. Ocular manifestations may also accompany the systemic disease. These rare infections usually have a self-limiting course, but severe systemic and ophthalmic complications may also occur. Therefore, to be familiar with the clinical findings of these entities can facilitate prompt diagnosis and prevention of potential morbidities.

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