scholarly journals How a Devastating Case of Acanthamoeba Sclerokeratitis Ended up with Serious Systemic Sequelae

2020 ◽  
Vol 11 (2) ◽  
pp. 348-355 ◽  
Author(s):  
Sophie Bataillie ◽  
Rita Van Ginderdeuren ◽  
Joachim Van Calster ◽  
Beatrijs Foets ◽  
Heleen Delbeke
Keyword(s):  
Histopathological Examination ◽  
Immunosuppressive Treatment ◽  
False Negative ◽  
Vitreous Body ◽  
Acanthamoeba Keratitis ◽  
Contact Lens Wearer ◽  
Soft Contact Lens ◽  
Immune Mediated ◽  
Unbearable Pain ◽  
Experienced Physician

A 35-year old soft contact lens wearer with a proven bilateral Acanthamoeba keratitis developed a nodular scleritis. Based on the stepladder approach described by Iovieno et al. [Ophthalmology. 2014 Dec;121(12):2340–7], nonsteroidal anti-inflammatory drugs, methylprednisolone, and later azathioprine were added to the antiamoebic treatment. Unfortunately, there was further deterioration and an endophthalmitis developed. Unbearable pain and concerns of spread to the brain urged an enucleation. Histopathological examination confirmed Acanthamoeba cysts in the cornea, sclera, retina, choroid, and vitreous body. As a side effect of the immunosuppressive treatment, the patient developed myopathy, pulmonary aspergillosis, and an avascular necrosis of the hip. Scleritis is a devastating complication of Acanthamoeba keratitis with a poor prognosis and a high enucleation rate. Acanthamoeba sclerokeratitis is, due to cyst-free biopsies, mostly assigned to an immune-mediated mechanism, justifying the use of immunosuppressive treatment. Scleritis in our case contributed to the extracorneal spread of Acanthamoeba. Our case is the first documented extracorneal spread of Acanthamoeba without previous surgery. Extracorneal spread of Acanthamoeba should be considered, even in the case of false-negative biopsies. We strongly recommend serial sections of the retrieved scleral specimen in case of negative histopathological examination to exclude an infection. Even when an immune-mediated scleritis is suspected, systemic immunosuppressive treatment should always be used with the greatest caution. Awareness of the side effects and monitoring by an experienced physician is mandatory.

scholarly journals POS1180 TREATMENT COMPLIANCE OF PATIENTS WITH RHEUMATOID ARTHRITIS DURING THE FIRST WAVE OF THE SARS-CoV-2/COVID-19 PANDEMIC IN PORTUGAL: RESULTS FROM THE COVID IN RA (COVIDRA) SURVEY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 871.2-871
Author(s):  
F. Araujo ◽  
N. Gonçalves ◽  
A. F. Mourão
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Diseases ◽  
Immunosuppressive Treatment ◽  
Treatment Compliance ◽  
Web Based ◽  
Symptoms Of Depression ◽  
Immune Mediated ◽  
Attending Physician ◽  
The Impact ◽  
E Mail

Background:The outcomes of the infection by the SARS-CoV-2 in patients with immune-mediated inflammatory diseases were largely unknown during the early days of the COVID-19 pandemic. It was hypothesized that these patients were at higher risk of morbidity and mortality due to their inherent immune dysfunction and immunosuppressive therapy. Several rheumatology societies issued recommendations urging patients not to stop their anti-rheumatic treatments.Objectives:To assess treatment compliance of patients with rheumatoid arthritis (RA) during the first wave of the SARS-CoV-2/COVID-19 pandemic in Portugal.Methods:The web-based survey COVIDRA (COVID in RA) was developed to assess the impact of the first wave mandatory confinement in patients with RA focusing on 5 domains: RA symptoms, attitudes towards medication, employment status, physical exercise and mental health. The questionnaire was sent to RA patients through e-mail and social media of the Portuguese Society of Rheumatology and two patient associations; and it was filled locally at two rheumatology centers in Lisbon. Recruitment took place during June and July 2020. Descriptive statistics were generated by the survey software and were afterwards transported and evaluated using appropriate biostatistics software.Results:We obtained 441 valid questionnaires. Most respondents were female (88.4%), caucasian (93.6%), with a mean age of 58 (+/-13) years. The majority (57.6%) had longstanding disease (>10 years) and were treated with csDMARDs (63.2%) and/or bDMARDs/tsDMARDS (23,7%). Only 14% (N=61) discontinued or reduced the dosage or frequency of their RA treatment. Most of these changes were previously planned by the attending physician (27.9%). Only 11 patients (18%) discontinued their immunosuppressive medication out of fear of becoming infected with SARS-CoV-2 (corresponding to 2.5% of total responders). Another 11 patients did so because they had no prescription, couldn’t go to the community/hospital pharmacy or couldn’t afford the medication. Although these numbers preclude any statistical analysis, when compared to patients who persisted on their treatment, those discontinuing due to fear of contagion were younger (56.4 vs 58.5 years), all female (100 vs 86.8%), with long-lasting disease (≥ 11 years) (90.9% vs 57.5%), more frequently treated with bDMARDs (36.4 vs 23.1%) and presenting more symptoms of depression (54.5 vs 49.7%).Conclusion:Most RA patients complied with their treatment during the first wave of the SARS-CoV-2 pandemic in Portugal. Only a minority changed their immunosuppressive treatment due to fear of SARS-CoV-2 infection. Very similar rates of immunosuppressive discontinuation due to fear of contagion were reported by other authors (such as Schmeiser et al, Pineda-sic et al and Fragoulis et al).Disclosure of Interests:Filipe Araujo Speakers bureau: Pfizer, Biogen, Novartis, Menarini, Consultant of: MSD, Nuno Gonçalves: None declared, Ana Filipa Mourão: None declared.

scholarly journals Histopathological specialized staining of oral lichen planus-induced fibrotic changes and surgical treatment of associated restricted mouth opening: a case report

2021 ◽  
Vol 45 (1) ◽  
Author(s):  
Atsushi Shudo
Keyword(s):  
Surgical Treatment ◽  
Lichen Planus ◽  
Oral Lichen Planus ◽  
Histopathological Examination ◽  
Mouth Opening ◽  
Ki 67 ◽  
Collagen Formation ◽  
Immune Mediated ◽  
Cytokeratin 13 ◽  
Oral Lichen

Abstract Background Oral lichen planus is a chronic inflammatory and immune-mediated disease that affects the oral mucosa. Recent findings have suggested that oral lichen planus is often associated with submucosal fibrotic changes. Fibrotic changes in the buccal submucosa may cause restricted mouth opening. This report discusses the histopathological examination (including specialized staining) and surgical treatment for oral lichen planus-induced fibrotic changes. Case presentation Here, we describe a 63-year-old woman who had oral lichen planus with fibrotic changes. Her maximum mouth opening distance was approximately 30 mm due to submucosal fibrotic changes, and she exhibited gradual fibrosis progression. Histological examinations were performed to assess the oral lichen planus-induced fibrotic changes. Then, double Z-plasty were performed as treatment for restricted mouth opening. The immunohistochemical staining results were negative for cytokeratin 13 and positive in some layers for cytokeratin 17 and Ki-67/MIB-1. Masson's trichrome staining showed enhanced collagen formation. Postoperative mouth opening training enabled the patient to achieve a mouth opening distance of > 50 mm. Conclusion Our findings suggest that histopathological examination with specialized staining can aid in the evaluation of oral lichen planus-induced fibrotic changes, and that Z-plasty is effective for the treatment of restricted mouth opening due to oral lichen planus.

A Case of Alcaligenes xylosoxidans Keratitis in a Soft Contact Lens Wearer

2010 ◽  
Vol 51 (11) ◽  
pp. 1525 ◽  
Author(s):  
Yang Kyung Cho ◽  
Dong Hyun Gi ◽  
Hyun Kyung Kim ◽  
Tae Yoon La
Keyword(s):  
Contact Lens ◽  
Soft Contact ◽  
Contact Lens Wearer ◽  
Soft Contact Lens

Autoimmune Epilepsy: The Evolving Science of Neural Autoimmunity and Its Impact on Epilepsy Management

2018 ◽  
Vol 38 (03) ◽  
pp. 290-302 ◽  
Author(s):  
Orna O'Toole ◽  
Amy Quek
Keyword(s):  
Patient Outcomes ◽  
Treatment Options ◽  
Immunosuppressive Treatment ◽  
Substantial Reduction ◽  
Risk Scores ◽  
Seizure Freedom ◽  
Clinical Approach ◽  
Treatment Trial ◽  
Autoimmune Epilepsy ◽  
Immune Mediated

AbstractAutoimmune epilepsy is increasingly recognized as a distinct clinical entity, driven in large part by the recent discovery of neural autoantibodies in patients with isolated or predominant epilepsy presentations. Detection of neural autoantibodies in high-risk epilepsy patients supports an immune-mediated cause of seizures and, if applicable, directs the search for an underlying cancer when the paraneoplastic association of the associated antibody is compelling. Early diagnosis of autoimmune epilepsy is crucial, as prompt initiation of immunosuppressive treatment increases the likelihood of achieving either seizure freedom or a substantial reduction in seizure frequency. A practical clinical approach that incorporates risk scores to guide patient selection on the basis of clinical features, neural autoantibodies, and a treatment trial of immunotherapy is suggested. Elucidating an immunological basis of epilepsy provides neurologists with wider treatment options (incorporating immune-suppressive treatment), in addition to standard antiepileptic drugs, which often improves patient outcomes.

Toxoplasma gondii-associated cholecystitis in a cat receiving immunosuppressive treatment

2019 ◽  
Vol 47 (06) ◽  
pp. 453-457 ◽  
Author(s):  
Francesco Lo Piccolo ◽  
Kathrin Busch ◽  
Jelena Palić ◽  
Vera Geisen ◽  
Katrin Hartmann ◽  
...  
Keyword(s):  
Toxoplasma Gondii ◽  
Immunosuppressive Treatment ◽  
Clinical Signs ◽  
Abdominal Ultrasound ◽  
Predisposing Factor ◽  
Bile Duct Wall ◽  
Immune Mediated ◽  
Bile Fluid ◽  
Bile Cytology ◽  
Toxoplasma Gondii Infection

AbstractA 9-year-old female neutered domestic shorthair cat diagnosed with immune-mediated thrombocytopenia that was treated with prednisolone and cyclosporine, was presented for anorexia, vomiting, increased liver enzymes, and hyperbilirubinemia. Abdominal ultrasound revealed a markedly thickened gallbladder and common bile duct wall. Bile cytology detected severe neutrophilic inflammation and protozoal zoites. Suspected Toxoplasma gondii infection was confirmed by real-time PCR of bile. The cat was treated with clindamycin and ursodeoxycholic acid for 6 weeks, recovered and remained stable for 2 years despite ongoing immunosuppressive treatment. Thereafter, the cat was presented with suspicion of intestinal lymphoma, and recurrence of toxoplasmosis was diagnosed. Following treatment with clindamycin and prednisolone over 4 weeks the cat was euthanized. This is the first report of Toxoplasma gondii zoites detected in bile fluid from a cat with cholecystitis. Pathogenesis of toxoplasmosis in cats is still not fully understood. Although immunosuppression can represent a relevant predisposing factor, other factors, such as virulence of the parasite and genetic polymorphism of the host, can also play an important role. Toxoplasmosis should be included as a differential diagnosis in cats developing clinical signs of an inflammatory disease while receiving immunosuppressive treatment.

scholarly journals AcanthamoebaSpecies Keratitis in a Soft Contact Lens Wearer Molecularly Linked to Well Water

2006 ◽  
Vol 17 (2) ◽  
pp. 120-122 ◽  
Author(s):  
Samira Mubareka ◽  
Michelle Alfa ◽  
Godfrey K Harding ◽  
Gregory Booton ◽  
Marilyn Ekins ◽  
...  
Keyword(s):  
Contact Lens ◽  
Present Report ◽  
Well Water ◽  
Soft Contact ◽  
Contact Lens Wearer ◽  
Contact Lens Wear ◽  
Soft Contact Lens ◽  
First Case ◽  
Primary Care Practitioners ◽  
High Degree

Acanthamoebaspecies keratitis has been associated with soft contact lens wear. In the present report, an epidemiological link was established between the patient's isolate and well water from the home using molecular methods. To the authors' knowledge, this is the first case in Canada where such a link has been established. Primary care practitioners and specialists, including ophthalmologists and infectious diseases specialists, must maintain a high degree of clinical suspicion in soft contact lens wearers with keratitis unresponsive to conventional topical and systemic treatment.

scholarly journals Microbial keratitis following cocaine abuse in a soft contact lens wearer

Eye ◽  
1999 ◽  
Vol 13 (2) ◽  
pp. 264-265 ◽  
Author(s):  
Dipak N Parmar ◽  
Fiona Robinson ◽  
Paul A Hunter
Keyword(s):  
Contact Lens ◽  
Cocaine Abuse ◽  
Microbial Keratitis ◽  
Soft Contact ◽  
Contact Lens Wearer ◽  
Soft Contact Lens

Acanthamoeba keratitis due to genotype T11 in a rigid gas permeable contact lens wearer in Spain

2011 ◽  
Vol 34 (2) ◽  
pp. 83-86 ◽  
Author(s):  
Jacob Lorenzo-Morales ◽  
Rafael Morcillo-Laiz ◽  
Carmen Mª Martín-Navarro ◽  
Rogelio López-Vélez ◽  
Atteneri López-Arencibia ◽  
...  
Keyword(s):  
Contact Lens ◽  
Acanthamoeba Keratitis ◽  
Contact Lens Wearer

scholarly journals Sequence Analysis of TNFRSF13b, Encoding TACI, in a Patient with Very Early Onset Inflammatory Bowel Disease: a Case Report

2018 ◽  
Vol 1 (4) ◽  
pp. 110
Author(s):  
Jiaying Shen
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Early Onset ◽  
Clinical Laboratory ◽  
Histopathological Examination ◽  
Immunosuppressive Treatment ◽  
Poor Response ◽  
Compound Heterozygous ◽  
Inflammatory Bowel ◽  
Compound Heterozygous Mutations

Very early onset inflammatory bowel disease (VEO-IBD), IBD diagnosed before 6 years of age, frequently presents with increased severity, aggressive progression, and often poor response to conventional treatments. Although the cause of IBD is generally considered to be intestinal immune dysfunction induced by polygenic mutations and environment and other factors, VEO-IBD has a stronger genetic susceptibility specifically the neonatal- or infantile-onset IBD. Herein we report compound heterozygous mutations in the tumor necrosis factor receptor superfamily member 13b (TNFRSF13B) gene in a 3-year-old male that was admitted to our hospital with lasted jaundice, repeated fever and diarrhea in May 2014 at 2-month-old. He was diagnosed with VEO-IBD based on clinical, laboratory and histopathological examination. However, he was unresponsive to the conventional therapy, including the nutritional support therapy, antibiotic and immunosuppressive treatment, and surgical release of neonatal intestinal obstruction. Novel compound heterozygous mutations, c.[365G>A];[452C>T](p.[R122Q];[P151L]), were discovered in TNFRSF13B, encoding TACI, for this patient.

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