scholarly journals Bilateral Birdshot Retinochoroiditis and Retinal Astrocytoma

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Sunil Mamtora ◽  
Yun Wong ◽  
Dugald Bell ◽  
Teresa Sandinha
Keyword(s):  
Tuberous Sclerosis ◽  
Retinal Vasculitis ◽  
Significant Past Medical History ◽  
Fluorescein Angiogram ◽  
Disease Modifying Drugs ◽  
Birdshot Retinochoroiditis ◽  
History Of ◽  
Ocular Finding ◽  
Disease Modifying ◽  
The Right

Background. This case highlights the importance of recognising multiple pathologies within the eye which may not necessarily be linked. Both birdshot retinochoroiditis and astrocytoma are rare conditions. The case underlines the need for early identification and treatment of birdshot retinochoroiditis with steroids and disease modifying drugs. Astrocytoma in the absence of tuberous sclerosis is also uncommon. Case Presentation. A 36-year-old male presented with 3-month history of bilateral progressive flashing lights and floaters. He was systemically well with no significant past medical history. Fundal examination revealed retinal vasculitis and active creamy lesions in the choroid radiating from the optic nerve. In the supranasal periphery of the right eye there was a raised white, jagged lesion protruding into the vitreous. Fluorescein angiogram and indocyanine green showed marked venous vasculitis, hypofluorescence, and disc leakage in keeping with birdshot retinochoroiditis. The supranasal lesion features were in keeping with astrocytoma and this was thought to be a coincidental finding. Conclusions. Retinal astrocytoma may be present as an isolated ocular finding; however, patients must still be investigated for tuberous sclerosis which is the most common association. Birdshot retinochoroiditis typically responds well to steroid therapy, and disease modifying drugs should be considered as soon as possible.

Lyme disease atypically presenting with a singular symptom: Unilateral chorioretinitis

2020 ◽  
pp. 112067212096205
Author(s):  
Erol Havuz ◽  
Seda Güdül Havuz
Keyword(s):  
Visual Acuity ◽  
Lyme Disease ◽  
Retinal Vasculitis ◽  
Ocular Involvement ◽  
Ischemic Optic Neuropathy ◽  
Sudden Loss ◽  
Patient Reported ◽  
History Of ◽  
Verification Test ◽  
The Right

Background: Lyme disease, caused by Borrelia burgdorferi, is a spirochetal disease. Lyme disease-related ocular findings may also provide important clues. Ocular involvement is most commonly seen as uveitis, chorioretinitis, conjunctivitis, keratitis, episcleritis, papillitis, panuveitis, ischemic optic neuropathy, papilledema, and retinal vasculitis. Case: A 27-year-old male patient was admitted with a history of fatigue, malaise, and sudden loss of vision in his left eye for 3 days. The best visual acuity was found 20/20 in the right eye and 20/400 in the left eye. Fluorescein fundus angiography showed no pathological findings in the right eye; but hyperfluorescence that was compatible with choroiditis foci was seen in the left eye. Optical coherence tomography (OCT) showed choroidal thickening in the left eye compared to the right eye. Lyme IgM antibody was found to be positive, explaining choroiditis etiology, while IgG values were found to be negative. Western blot verification test was positive. The patient was treated with 2 × 100 mg doxycycline (21 days) with a diagnosis of Lyme disease, prednol 1 mg/kg/day (10 days) for choroiditis. Omeprazole tablets were given 1 × 1 during the period of cortisone intake. On the third day of treatment, visual acuity increased to 20/200 and continued to increase until reaching 20/20 in the second week. Conclusions: Lyme disease is rare, but must be kept in mind when investigating the etiology of chorioretinitis and retinal vasculitis. The patient reported here is, to our knowledge, the second case reported in literature that shows atypical clinic for Lyme disease with unilateral chorioretinitis without Erythema chronicum migrans (ECM).

Cytomegalovirus Retinitis in a Patient Taking Tocilizumab: A Case Report

2020 ◽  
Vol 4 (3) ◽  
pp. 233-235
Author(s):  
Erin S. Ong ◽  
John T. Thompson
Keyword(s):  
Case Report ◽  
Primary Open Angle Glaucoma ◽  
African American Woman ◽  
Open Angle Glaucoma ◽  
American Woman ◽  
Significant Past Medical History ◽  
Cmv Retinitis ◽  
History Of ◽  
Polymerase Chain ◽  
The Right

Purpose: This report discusses a case of cytomegalovirus (CMV) retinitis in a patient taking tocilizumab for maintenance and remission of giant cell arteritis (GCA). Methods: A case report is presented. Results: A 78-year-old African American woman with no significant past medical history and an ocular history of primary open-angle glaucoma presented to the retina clinic with vitritis in the right eye. Four months earlier, she had been diagnosed with biopsy-proven GCA and prescribed 30 mg of prednisone daily and 162 mg tocilizumab subcutaneously weekly. Diagnostic vitrectomy with polymerase chain reaction of the vitreous was positive for CMV. Her retinitis gradually resolved after 3 months of treatment with valganciclovir, with no recurrence 4 months after discontinuing the valganciclovir. Conclusions: Physicians should be aware of the potential to develop CMV retinitis in the setting of tocilizumab use for GCA treatment.

scholarly journals Peripheral Retinal Neovascularization in a Patient with Sarcoidosis and Cocaine-Associated Autoimmunity

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Ramak Roohipourmoallai ◽  
Samaneh Davoudi ◽  
Seyed Majid Hosseinian Benvidi ◽  
Siva S. R. Iyer
Keyword(s):  
Macular Hole ◽  
Cocaine Abuse ◽  
Systemic Vasculitis ◽  
Retinal Vasculitis ◽  
Visual Disturbance ◽  
Lymph Node Biopsy ◽  
African American Female ◽  
Full Thickness Macular Hole ◽  
History Of ◽  
The Right

A 63-year-old African-American female with history of sarcoidosis (lymph node biopsy proven) and cocaine abuse for 8 years was referred to us because of new floater. Her ocular history was unremarkable except for vague complaints of visual disturbance during a hospital admission in 2016. On presentation, her visual acuity was 20/400 in the right eye and 20/30 in the left eye. Dilated fundus exam and multimodal imaging showed thick epiretinal membrane (ERM) superior to optic nerve head causing a lamellar macular hole and intra retinal edema in the right eye, a full thickness macular hole, and peripheral neovascularization in the left eye. Peripheral vasculitis was appreciated in both eyes and peripheral neovascularization in the left eye on fluorescein angiography. The patient underwent laser therapy, and the new vessels regressed in the left eye without any changes in systemic medications. Multiple factors may contribute to retinal vasculitis and neovascularization including sarcoidosis, cocaine abuse, and other undiagnosed systemic vasculitis, which makes this case a mystery.

scholarly journals Pulmonary puzzle: A rare case of dysphagia

2016 ◽  
Vol 22 (3) ◽  
pp. 73
Author(s):  
S Sinha Roy ◽  
Coenraad F N Koegelenberg ◽  
E M Isusen
Keyword(s):  
Aortic Arch ◽  
Chest Radiograph ◽  
Left Subclavian Artery ◽  
Significant Past Medical History ◽  
Descending Aorta ◽  
Specialist Physician ◽  
Abnormal Chest ◽  
Kommerell’S Diverticulum ◽  
History Of ◽  
The Right

<p>A 58-year-old man presented with a longstanding history of dysphagia and sensation of something lodged in the back of his throat. He had no significant past medical history, was a smoker (30 pack-years) and used &gt;60 units of alcohol per week. A physical examination was unremarkable. The patient was referred to the respiratory clinic at Tygerberg Hospital, Cape Town, by a specialist physician who was concerned about the patient’s abnormal chest radiograph (Fig. 1). The chest radiograph showed that the normal left-sided aortic arch and the usual companion descending aorta were absent. The arch coursed to the right with the descending aorta also on the right. A computed tomography (CT) scan (Figs 2 and 3) and reconstructions (Figs 4 and 5) confirmed the right-sided aortic arch with a retrooesophageal aberrant left subclavian artery and formation of a Kommerell’s diverticulum at the origin. In the absence of major complications, he was managed conservatively.</p>

Aortic Thrombus Embolization in A Patient with Tuberous Sclerosis

2021 ◽  
Author(s):  
Steven Wolf ◽  
Andrew Rhoads ◽  
William Gomes ◽  
Philip Overby ◽  
Patricia McGoldrick
Keyword(s):  
Cerebral Infarction ◽  
Tuberous Sclerosis ◽  
Genetic Disorder ◽  
Altered Mental Status ◽  
Unknown Etiology ◽  
Benign Tumors ◽  
Organ Systems ◽  
Aortic Thrombus ◽  
History Of ◽  
The Right

AbstractTuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder affecting many organ systems. Patients commonly develop a variety of benign tumors as well as neurological disease, including seizures, autism, and cognitive delay. We report here the case of an adolescent patient with TSC and a history of mild COVID-19 who presented with a 1-day history of altered mental status. The patient was found to have ischemic cerebral infarction of the right MCA and ACA territories. Initial angiography showed an occlusion of the right internal carotid artery without a demonstrable etiology, with follow-up echocardiography and angiography revealing a large aortic thrombus. The patient was not a candidate for thrombus removal due to her cerebral infarct and received medical anticoagulation. Thrombosis progressed to involve the left ICA, with left cerebral infarction and subsequent death. Aortic thrombus embolization as a cause of cerebrovascular accident (CVA) is a novel finding in the setting of TSC and should be considered for pediatric patients with CVA of unknown etiology. It is unclear whether this was related to the prior COVID-19 infection.

scholarly journals Foveal reorganization after treatment of acute foveal toxoplasmic retinochoroiditis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mojtaba Abrishami ◽  
Seyedeh Maryam Hosseini ◽  
Solmaz Momtahen ◽  
Ghodsieh Zamani
Keyword(s):  
Visual Acuity ◽  
Retinal Vasculitis ◽  
Case Presentation ◽  
Visual Improvement ◽  
Counting Finger ◽  
History Of ◽  
Toxoplasmic Retinochoroiditis ◽  
Optical Coherence Tomography Imaging ◽  
The Right ◽  
Timely Treatment

Abstract Purpose To report a patient with impaired vision due to foveal involvement of toxoplasmic retinochoroiditis, who was successfully treated with intravitreal clindamycin and dexamethasone and oral therapy with azithromycin, trimethoprim-sulfamethoxazole, and prednisolone and led to successful visual and anatomic recovery. Case presentation A 32-year-old man presented with three-day history of gradually decreasing visual acuity, redness, pain and photophobia of the right eye. Anterior chamber cellular reaction, vitritis and a white retinochoroiditis patch with adjacent retinal vasculitis in the fovea was suggestive of the toxoplasmic retinochoroiditis. He was treated with intravitreal clindamycin and dexamethasone injection followed by six-week regimen of azithromycin, trimethoprim-sulfamethoxazole, and prednisolone. In serial optical coherence tomography imaging, retinitis patch changed to cavitary foveal destruction. Fovea reorganized gradually, and visual acuity concurrently improved from counting finger 3 m to 20/25. Conclusion In foveal toxoplasmic retinochoroiditis lesions, timely treatment is associated with retinal reorganization and visual improvement.

scholarly journals Foveal Regeneration after Treatment of Acute Foveal Toxoplasmic Chorioretinitis

2021 ◽  
Author(s):  
Mojtaba Abrishami ◽  
Seyedeh Maryam Hosseini ◽  
Solmaz Momtahen ◽  
Ghodsieh Zamani
Keyword(s):  
Visual Acuity ◽  
Retinal Vasculitis ◽  
Case Presentation ◽  
Visual Improvement ◽  
Counting Finger ◽  
History Of ◽  
Optical Coherence Tomography Imaging ◽  
The Right ◽  
Toxoplasmic Chorioretinitis ◽  
Timely Treatment

Abstract Purpose: To report a patient with impaired vision due to foveal involvement of toxoplasmic chorioretinitis, who was successfully treated with intravitreal and oral therapy and led to successful visual and anatomic recovery.Case presentation: A thirty two-year-old man presented with three-day history of gradually decreasing visual acuity, redness, pain and photophobia of the right eye. Anterior chamber cellular reaction, vitritis and a white retinochoroiditis patch with adjacent retinal vasculitis in the fovea was suggestive of the toxoplasmic chorioretinitis. He was treated with intravitreal Clindamycin and Dexamethason injection followed by six-week regimen of Azithromycine, Trimethoprim-Sulfamethoxazole, and Prednisolone. In serial optical coherence tomography imaging, retinitis patch changed to cavitary foveal destruction. Fovea was regenerated gradually, and visual acuity was concurrently improved from counting finger 3m to 20/25. Conclusion: In foveal toxoplasmic chorioretinitis lesions, timely treatment is associated with retinal regeneration and visual improvement.

scholarly journals Subependymal giant cell astrocytoma with high choline/creatine ratio on proton MR spectroscopy

2006 ◽  
Vol 64 (3b) ◽  
pp. 877-880 ◽  
Author(s):  
Arnolfo de Carvalho Neto ◽  
Emerson L. Gasparetto ◽  
Isac Bruck
Keyword(s):  
Tuberous Sclerosis ◽  
Giant Cell ◽  
Mr Spectroscopy ◽  
Subependymal Giant Cell Astrocytoma ◽  
Foramen Of Monro ◽  
Proton Mr Spectroscopy ◽  
History Of ◽  
The Right ◽  
Subependymal Nodules ◽  
Giant Cell Astrocytoma

OBJECTIVE: To report a case of subependymal giant cell astrocytoma (SEGA) in a patient with tuberous sclerosis, emphasizing the proton MR spectroscopy (MRS) findings. CASE: A three year-old boy with tuberous sclerosis presented with a 3-month history of mild headache. The physical examination showed discrete mental retardation and multiple hypomelanic macules in the legs and back. MRI showed many cortical tubers and subependymal nodules. At the left foramen of Monro, there was a 15 mm nodule, with heterogeneous signal on T1 and T2-weighted images, and strong enhancement after contrast administration. MRS study (multi-voxel PRESS, TE=144ms) showed the following ratios: a) left foramen of Monro nodule N-acetylaspartate (NAA)/creatine (Cr)=0.93 and Choline (Cho)/Cr=1.6 and b) at the right Monro foramen NAA/Cr=1.56 and Cho/Cr=1.29. CONCLUSION: The MRS performed at the SEGA may show high Cho/Cr and low NAA/Cr ratios, similar to the other brain neoplasms. As a consequence, MRS may be a valuable tool for the early detection of neoplastic transformation of subependymal nodules near the foramina of Monro in patients with tuberous sclerosis.

Z-line degradation and phagocytosis of sarcomeric fragments in myonecrosis

1983 ◽  
Vol 41 ◽  
pp. 790-791
Author(s):  
Melinda L. Estes ◽  
Samuel M. Chou
Keyword(s):  
Vastus Lateralis ◽  
Inflammatory Myopathy ◽  
Muscle Disease ◽  
White Female ◽  
Inflammatory Cell Infiltrate ◽  
Limb Weakness ◽  
Muscle Diseases ◽  
History Of ◽  
The Right ◽  
Mononuclear Inflammatory Cell

Many muscle diseases show common pathological features although their etiology is different. In primary muscle diseases a characteristic finding is myofiber necrosis. The mechanism of myonecrosis is unknown. Polymyositis is a primary muscle disease characterized by acute and subacute degeneration as well as regeneration of muscle fibers coupled with an inflammatory infiltrate. We present a case of polymyositis with unusual ultrastructural features indicative of the basic pathogenetic process involved in myonecrosis.The patient is a 63-year-old white female with a one history of proximal limb weakness, weight loss and fatigue. Examination revealed mild proximal weakness and diminished deep tendon reflexes. Her creatine kinase was 1800 mU/ml (normal < 140 mU/ml) and electromyography was consistent with an inflammatory myopathy which was verified by light microscopy on biopsy muscle. Ultrastructural study of necrotizing myofiber, from the right vastus lateralis, showed: (1) degradation of the Z-lines with preservation of the adjacent Abands including M-lines and H-bands, (Fig. 1), (2) fracture of the sarcomeres at the I-bands with disappearance of the Z-lines, (Fig. 2), (3) fragmented sarcomeres without I-bands, engulfed by invading phagocytes, (Fig. 3, a & b ), and (4) mononuclear inflammatory cell infiltrate in the endomysium.

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