scholarly journals P32 Relapsing polychondritis with anterior scleritis in young female

2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Umair Arain ◽  
Abimbola Phillips ◽  
Ben Burton ◽  
Damodar Makkuni
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Visual Fields ◽  
Delayed Diagnosis ◽  
Relapsing Polychondritis ◽  
Young Female ◽  
Blurred Vision ◽  
Ocular Findings ◽  
Anterior Scleritis ◽  
The Right

Abstract Case report - Introduction Relapsing polychondritis (RP) was first recognized as a clinical entity in 1923 by Jaksch-Wartenhorst (1923) and reported by him under the title "polychondropathia". The term "relapsing polychondritis" was first used by Pearson, Kline, and Newcomer (1960). Because the ocular findings can be the initial findings of RP, ophthalmologists should know the major ocular findings of this disease. Isaak et al reported that the most common ocular finding is episcleritis (39%) and the second is scleritis (14%). Other signs are iritis (9%), retinopathy (9%), muscle paresis (5%), and optic neuritis (5%). Case report - Case description A 45-year-old female with known rheumatoid arthritis referred by rheumatology in eye clinic due to blurred vision and dry eye. The patient was on hydroxychloroquine and sulfasalazine. No retinal toxicity was found on examination, OCT and Visual Fields. The vision was 6/6 both eyes. Follow-up was in 12 months. She presented 6 months later in casualty with severe pain in her right eye. Examination showed diffuse anterior scleritis with secondary conjunctival inflammation. Anterior chamber cells present. Posterior segment showed no inflammation. Left eye was unremarkable. She was started on Froben 100mg tds with omeprazole. She was seen after a week and condition was improving. She was asked to taper off the meds. Inflammation resolved with 6/5 vision in both eyes and the next appointment was made in a year to monitor for hydroxychloroquine toxicity. In November 2020 she was seen by ENT with inflammation of the right ear cartilage. The pictures showed that the pinna was spared and cartilage was only involved. There was nasal crusting and stuffy nose but without any respiratory symptoms. She was prescribed 50mgs of prednisolone and this helped with her inflammation. She was seen by rheumatology later on and hydroxychloroquine and sulfasalazine was stopped, and she was started on methotrexate 10mgs weekly and folic acid 5mg weekly. Pulmonary function test and echocardiogram was ordered. The case was discussed in MDT rheumatology and it was decided that if joint symptoms got worse than biologics could be started. Methotrexate increased to 15mg subcut. Echocardiogram was normal with satisfactory blood tests. Her next appointment is in October 2021. Case report - Discussion Initially the patient was diagnosed with rheumatoid arthritis with ocular inflammation (anterior scleritis) and was given the standard treatment of steroids to which the patient responded as well. Later when she developed the ear inflammation which involved only the cartilage the diagnosis was revised by rheumatology and changed to RP. As this is a rare life-threatening disease management was switched to immunosuppressive therapy to which she is currently responding well. Case report - Key learning points It is important to consider the possibility that a rheumatology patient may have more than one diagnosis or be open to the idea of revising the diagnosis as the clinical picture evolves over the time. Given the nature of the disease all the systemic features should be examined thoroughly as any one missed area can lead to delayed diagnosis.

scholarly journals A case report of DOPA-responsive dystonia in a young woman

2020 ◽  
pp. 45-48
Author(s):  
NA Belykh ◽  
MA Akhkyamova ◽  
VV Gusev ◽  
OA Lvova
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Genetic Predisposition ◽  
Emergency Treatment ◽  
Sanger Sequencing ◽  
Clinical Case ◽  
Young Female ◽  
Considerable Improvement ◽  
The Right ◽  
Pediatric Onset

Dopa-responsive dystonia (DRD) is a rare progressive genetically heterogenous disorder with pediatric onset. DRD is 3 times as prevalent in women than in men. This article reports a clinical case of DRD in a young female presenting with paraparesis, foot dystonia (more pronounced in the right foot) and pronounced walking impairment, who was admitted for emergency treatment to a Neurology Unit. Based on the additional tests, which included a levodopa trial and Sanger sequencing, the patient was diagnosed with DRD. Levodopa caused a considerable improvement of the symptoms. The article describes the clinical features of the disease, talks about its differential diagnosis, genetic predisposition and treatment strategy.

scholarly journals Optic perineuritis secondary to hyaluronic acid injections: a case report

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yanjun Hu ◽  
Yingjun Wang ◽  
Yuhua Tong
Keyword(s):  
Hyaluronic Acid ◽  
Oral Prednisolone ◽  
Young Female ◽  
Blurred Vision ◽  
Visual Field Examination ◽  
Case Presentation ◽  
Administration Method ◽  
The Right ◽  
Optic Discs ◽  
The Brain

Abstract Background Although a safe, excellent administration method for hyaluronic acid derivatives has been documented; improper injections can lead to devastating and irreversible consequences. Here, we present the first known case of optic perineuritis caused by hyaluronic acid. Case presentation A young female experienced sudden orbital pain in the right eye after receiving hyaluronic acid injections to the eyebrows. She presented to the eye clinic two weeks later, after developing blurred vision in the right eye. Visual acuity was reduced significantly in the right eye. Automated visual field examination showed defects in both eyes. Fundus examination revealed bilateral swelling of optic discs. Magnetic resonance imaging of the brain demonstrated bilateral perineural enhancement consistent with optic perineuritis. The patient was treated with retrobulbar injection of hyaluronidase and oral prednisolone. Her vision improved with treatment. Conclusions The prognosis for visual outcomes in patients with optic perineuritis is generally excellent. However, a poor prognosis is associated with delays to the initiation of treatment. Recognizing this condition is important, and treatment with corticosteroids should be initiated early.

The unusual case of neck lymphadenopathy - oculoglandular form of tularemia

2018 ◽  
Vol 7 (2) ◽  
pp. 1-5
Author(s):  
Katarzyna Baranowska-Kempisty ◽  
Jolanta Kluz-Zawadzka ◽  
Sylwia Warzybok-Bajda ◽  
Krzysztof Szuber
Keyword(s):  
Adverse Effect ◽  
Case Report ◽  
Francisella Tularensis ◽  
Unusual Case ◽  
Drug Research ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Elisa Test ◽  
Gram Negative ◽  
The Right

Tularemia is anthropozoonosis caused by Bacteria Francisella tularensis a gram negative, non-motile aerobic bacillus.[5][8] The bacteria is transmitted mostly by rabbits, hares, rodents and arthropods. The pathogen penetrates into an organism via damaged skin, conjunctiva or mucosa- either through inhalation or ingestion. The clinical manifestations depend on the route of acquisition. Six forms of the disease can be distinguished: ulceroglandular or glandular, oculoglandular, oropharyngeal, respiratory, typhoidal, and intestinal. [11] We present a case report of the rarest oculoglandular form of tularemia. The patient was admitted to the hospital with right pre-auricular swelling, right sided neck lymphadenopathy, conjunctivitis and a nodule of the right eyelid. After excluding more common differential diagnoses, an ELISA test was performed and Francisella tularensis antibodies were identified. Patient administered proper antibiotic therapy. Tularemia is a rarely occurring disease in Poland and is nearly never taken into consideration by otolaryngologists when diagnosing patients with neck lymphadenopathy. In clinical practice, otorhinolaryngologists should always consider this infectious zoonosis, especially the oculoglandular and oropharyngeal forms, as delayed diagnosis and treatment may causes serious health consequences in patients. In the future new drug research should be conducted because of the adverse effect of widely used medications specially for children and pregnant woman.

scholarly journals Delayed Diagnosis of Ewing's Sarcoma of the Right Humerus Initially Treated as Chronic Osteomyelitis: A Case Report

2005 ◽  
Vol 13 (1) ◽  
pp. 88-92 ◽  
Author(s):  
BPB Tow ◽  
MH Tan
Keyword(s):  
Case Report ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Chronic Osteomyelitis ◽  
Delayed Diagnosis ◽  
Delay In Diagnosis ◽  
Limited Stage ◽  
History Of ◽  
Anti Inflammatory ◽  
The Right

We report a case of limited stage Ewing's sarcoma which was initially treated as chronic osteomyelitis for 3 years. A 24-year-old man presented with a one-week history of pain in the right arm and fever, with histology suggestive of osteomyelitis of the affected humerus. He developed multiple relapses of pain and fever; each episode responded to antibiotic treatment. A second biopsy was performed 3 years later and confirmed a diagnosis of Ewing's sarcoma. Despite a 3-year delay in diagnosis, the disease remained localised. This case report highlights an atypical facet of the natural history of Ewing's sarcoma: a response to antibiotic and anti-inflammatory agents, and the limited stage of the disease despite a misdiagnosis of 3 years. This suggests the possibility that anti-inflammatory agents exert an inhibitory effect on the tumour growth. We also highlight the newer histologic and immunologic staining used in the diagnosis of Ewing's sarcoma.

scholarly journals Enterococcal endocarditis: A case report

2009 ◽  
Vol 62 (11-12) ◽  
pp. 583-586 ◽  
Author(s):  
Dejan Cvjetkovic ◽  
Mirjana Aleksic-Djordjevic ◽  
Jovana Jovanovic ◽  
Ivana Hrnjakovic-Cvjetkovic ◽  
Sandra Stefan-Mikic ◽  
...  
Keyword(s):  
Case Report ◽  
Unknown Origin ◽  
Heart Association ◽  
Complete Recovery ◽  
Young Female ◽  
Young Females ◽  
Echocardiographic Finding ◽  
Echocardiographic Examination ◽  
Infective Disease ◽  
The Right

Introduction. Bacteria from genus Enterococcus may cause infections mostly in those who are immunocompromised and those who underwent endoscopic or surgical procedures. Endocarditis is caused by enterococci in 5-10% of cases. Its clinical presentation does not differ from endocarditis of other bacterial origin. Previous susceptibility testing is needed for appropriate choice of antibiotics against enterococci. The treatment recommendations for enterococcal endocarditis were given by American Heart Association recently. Case report. A case of enterococcal endocarditis in a young female person hospitalised at Clinic for infectious diseases was reviewed. The disease was diagnosed during an extensive diagnostic procedure. Multiply repeated echocardiographic examination helped to find out bacterial vegetations on the mitral valve. Enterococcus species was isolated from several blood cultures. Despite powerful antibiotic treatment, the additional valvular replacement had to be done. Discussion. A case of enerococcal endocarditis in a young female person was reviewed. The right diagnosis was based on a thorough clinical examination in cooperation with cardiologists using repeated transthoracic and transesophageal echocardiography. Echocardiography, even if it is transesophageal, has limited sensitivity and specify, so it is sometimes necessary to be repeated for several times in diagnosing endocarditis. The source of endocarditis was not identified. The combined antimicrobial and surgical treatment led to the complete recovery of patient. Conclusion. Enterococcal endocarditis rarely occurrs in young females. Infective disease specialists sometimes face enterococcal endocarditis in their practice, mostly when they have to cope with fever of unknown origin. An appropriate approach to such conditions includes careful search for heart valve changes by repeated echocardiographic finding, if necessary.

scholarly journals Thrombosed orbital varix with mild, spontaneously resolving symptoms

Imaging ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 1-3
Author(s):  
Máté Magyar ◽  
Péter Barsi ◽  
Katalin Korányi ◽  
Pál Novák Kaposi
Keyword(s):  
Case Report ◽  
Direct Connection ◽  
Double Vision ◽  
Blurred Vision ◽  
Orbital Pain ◽  
Thin Walled ◽  
Small Varices ◽  
The Right ◽  
Orbital Varix ◽  
Pressure Sensation

AbstractOrbital varices are abnormally enlarged, thin walled veins in direct connection with normal orbital vessels. Stooping, bending, coughing or straining increase the venous tension and in this way can cause symptoms, such as bulging of the eyes (proptosis), orbital pain, bleeding, intermittent double vision. Small varices are managed by observation while larger lesions may require surgery. In our case report we demonstrate the case of a 72-year-old female patient with right sided retro-orbital pressure sensation for weeks, and exophthalmos with blurred vision for 1 week. MR investigation proved the presence of a partially thrombosed orbital varix on the right side, and a smaller, non-thrombosed varix on the left side. Observation was agreed, and the symptoms resolved spontaneously after several weeks.

scholarly journals Severe mycotic keratoconjunctivitis caused by Fusarium sp. in an immunocompetent child successfully treated with intravenous voriconazole and keratoplasty: case report and short review of the literature

2018 ◽  
Vol 6 ◽  
pp. 204993611881121
Author(s):  
Enrique Chacon-Cruz ◽  
Francisco Male-Valle ◽  
Rosa M. Rivas-Landeros ◽  
Erika Z. Lopatynsky-Reyes ◽  
Lucila A. Almada-Salazar ◽  
...  
Keyword(s):  
Case Report ◽  
Short Review ◽  
Fungal Species ◽  
Blue Staining ◽  
Fusarium Spp ◽  
Blurred Vision ◽  
First Case ◽  
Tropical Areas ◽  
Patient’S Outcome ◽  
The Right

Background: Pediatric mycotic infections in the eye are uncommon. However, ophthalmic infections by several fungal species have been described in immunocompetent subjects. Mycotic keratitis with or without conjunctivitis (MK) may account for more than 50% of all cases, particularly in tropical and sub-tropical areas. The leading mechanism is trauma. Treatment of MK is managed by medical (antifungal agents) and/or surgical means. This is the first case report of a patient with MK by Fusarium spp. successfully treated with keratoplasty and intravenous voriconazole, along with topical natamycin. Methods: Keratoplasty was performed and cultures obtained. Both Blood and Sabouraud Agars were used for cultures, and Lactophenol Cotton Blue Staining for microscopic observation. Results: A healthy, 10 year-old female, from the sub-tropical area of Sinaloa, Mexico, was admitted at both the CODET Vision Institute and the General Hospital of Tijuana, Mexico. Seven days after a direct trauma of the right cornea, the patient complained of progressive blurred vision, burning sensation, and itchiness. Clinical examination showed severe keratoconjunctivitis, and a necrotic slough on the cornea. Fungal colonies grew, and microscopic visualization showed typical ovoid, sickle-cell shaped macroconidia characteristics of Fusarium spp. The patient received intravenous voriconazole (200 mg every 12 h) and topical natamycin for 7 days prior and 6 days after keratoplasty. Topical natamycin was continued for 3 weeks. At 1-month follow-up, the patient’s outcome was significantly improved, with 90% vision recovery. Conclusion: This is the first pediatric case report of severe MK by Fusarium spp. successfully treated with combined intravenous voriconazole, keratoplasty and topical natamycin.

Active iris vascular tufts bleeding successfully treated with argon laser photocoagulation

2018 ◽  
Vol 28 (2) ◽  
pp. 241-242 ◽  
Author(s):  
Ambreen Sarmad ◽  
Fadi Alfaqawi ◽  
Monali Chakrabarti ◽  
Arijit Mitra ◽  
Bushra Mushtaq
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Case Report ◽  
Laser Photocoagulation ◽  
Argon Laser ◽  
Active Bleeding ◽  
Blurred Vision ◽  
Argon Laser Photocoagulation ◽  
The Right ◽  
Effective Use

Purpose: Iris vascular tufts (IVT) are rare biomicroscopic capillary outgrowths from the pupillary margins. Patients are usually asymptomatic until presenting with blurred vision due to spontaneous hyphema or with raised intraocular pressure. Case report: A 61-year-old woman presented to eye casualty with left eye (LE) blurred vision and discomfort for 1 day. Her external ocular examination was unremarkable and visual acuity was 6/6 in the right eye (RE) and 6/9 in the LE. Biomicroscopic examination revealed a 2-mm hyphema in her LE and bilateral multiple small IVT and active bleeding from IVT at the pupillary margin of the LE at the 5 o’clock position. Diagnosis of LE active bleeding from IVT was made and she underwent argon laser photocoagulation directed at the source of bleeding. The bleeding stopped immediately after the second burn. She was followed up for 3 months; her visual acuity was 6/5 and 6/6 in the RE and LE, respectively, with no further problems. Conclusions: Iris vascular tufts are benign and recurrent hemorrhages are unlikely. Therefore, definitive argon laser photocoagulation or surgical treatment are reserved to arrest further episodes of hyphema. Our case demonstrates the effective use of argon laser photocoagulation to completely arrest active bleeding from IVT and excellent recovery of hyphema with no further problems for 5 years.

scholarly journals Maximum intensity projection aids in diagnosing acute appendicitis and mobile caecum: A case report and literature review

2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Kakia A.F. Namugenyi ◽  
Ferdinand M. Oompie ◽  
Kasandji F. Kabambi
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Acute Appendicitis ◽  
Surgical Intervention ◽  
Delayed Diagnosis ◽  
Maximum Intensity Projection ◽  
Maximum Intensity ◽  
Post Processing ◽  
The Right ◽  
Childhood Condition

Appendicitis is a common childhood condition requiring surgical intervention and delayed diagnosis can have serious consequences. This report describes the case of a child who presented with an acute abdomen and intestinal obstruction. Multidetector (MD) CT demonstrated a left-sided caecum and an inflamed appendix with a faecolith. Maximum intensity projection (MIP) post-processing was key in identifying the appendicular artery and determine the diagnosis. At surgery, however, a mobile caecum and the appendix were positioned on the right side.

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