Extraocular muscle repositioning as the last therapeutic option for a patient with a severe course of Graves’ Ophthalmopathy: a case report

Abstract Background: Newly approved immunotherapeutic agents, like CTLA-4 inhibitors and antibodies against PD-1, are a promising therapeutic option in cancer therapy. Case presentation: A 74-year-old man, with a history of advanced stage melanoma and treatment with ipilimumab, pembrolizumab and nivolumab, was admitted to the hospital due to respiratory failure with hypoxemia and dyspnoea. He rapidly developed severe acute respiratory distress syndrome (ARDS), which required treatment in the intensive care unit which included mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Computed tomographic imaging (CT) showed signs of a pneumonitis, with an ARDS pattern related to the use of PD-1 antibodies. Treating the patient with high-dose immunosuppressive steroids led to an overall improvement. He was transferred to a rehabilitation hospital and subsequently to his home. Discussion and conclusion: This is a unique case report of a patient suffering a grade 4 adverse event under nivolumab who survived having been treated with ECMO. It highlights the possibility of associated adverse reactions as well as the use of ECMO in palliative care patients. ECMO can be of great success even in patients with malignancies, but careful decision making should be done on a case by case basis.

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The thickness of the retrobulbar portion of the optic nerve in Graves ophthalmopathy measured by ultrasound

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0906230s ◽

2009 ◽

Vol 137 (5-6) ◽

pp. 230-233

Author(s):

Ivan Stefanovic ◽

Jelena Paovic ◽

Igor Kovacevic ◽

Predrag Paovic

Keyword(s):

Optic Nerve ◽

Thyroid Gland ◽

Extraocular Muscle ◽

Test Methods ◽

Normal Limits ◽

Clinical Diagnostic ◽

Graves Ophthalmopathy ◽

Compressive Neuropathy ◽

Ocular Signs

Introduction. The clinical diagnostic of Graves ophthalmopathy is based on the association of ocular signs and the disease of the thyroid gland. The evolution of the disease involves the development of eye globe protrusion, extraocular muscle thickening pressuring the optic nerve, which can result in its thickness. Objective. The aim of the paper is to find whether the retrobulbar optic nerve thickened and if there was a correlation between its possible thickening and the thickness of the muscles in Graves ophthalmopathy. We also wished to test the theory of compressive aetiology of such thickening using a 30-degree test. Methods. We examined 28 patients with Graves ophthalmopathy. The thickness of the retrobulbar optic nerve was measured by ultrasound on a B-scan using the Schraeder's method and by the largest thickness of the internal muscle. Results. The thickness of the retrobulbar portion of the optic nerve in the 52 analyzed eyes with signs of the disease ranged between 3.24 mm to 6.30 mm, with median of 5.13 mm, indicating that the majority of the patients had optic nerve thickening rating at this value. Forty-eight eyes had a marked retrobulbar optic nerve thickening, with the thickening over 4 mm, while in 4 eyes with signs of Graves ophthalmopathy the thickness of the optic nerve was within normal limits. We detected that 92.3% of the patients with muscular thickening also had a directly proportional thickening of the retrobulbar optic nerve. By using the 30-degree test we confirmed the diagnosis of compressive neuropathy. Conclusion. Patients with Graves ophthalmopathy and thickened muscles, also have a thickening of the retrobulbar optic nerve; the rate of the thickness directly depends on the degree of the muscular thickness. The word is of compressive neuropathy, i.e. the thickness of the optic nerve is the result of subarachnoid fluid stasis caused by the compression on the optic nerve.

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Sight-Threatening Graves’ Ophthalmopathy during the Third Trimester of Pregnancy: A Case Report

The Tohoku Journal of Experimental Medicine ◽

10.1620/tjem.252.321 ◽

2020 ◽

Vol 252 (4) ◽

pp. 321-327

Author(s):

Kanako Sakurai ◽

Toshu Inoue ◽

Satsuki Niitsuma ◽

Ryota Sato ◽

Kazuhiro Takahashi ◽

...

Keyword(s):

Case Report ◽

Third Trimester ◽

The Third ◽

Graves Ophthalmopathy

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Management of tubal ectopic pregnancy with methotrexate in the setting of symptomatic Coronavirus disease 2019 (COVID-19): A case report

Facts, Views and Vision in ObGyn ◽

10.52054/fvvo.13.3.030 ◽

2021 ◽

Vol 13 (3) ◽

pp. 277-281

Author(s):

N.M. Millan ◽

J Morano ◽

L Florez ◽

J Carugno ◽

C.A. Medina

Keyword(s):

Case Report ◽

Literature Review ◽

Supportive Care ◽

Medical Management ◽

Patient Management ◽

Therapeutic Option ◽

Careful Consideration ◽

Management Options ◽

Tubal Ectopic Pregnancy ◽

Ectopic Pregnancies

Background: Coronavirus Disease 2019 (COVID-19) represents a complex therapeutic challenge. As the pandemic progresses, patients are presenting with ectopic pregnancies (EPs) and symptomatic COVID-19. Objective: We present the management of a patient with multiple medical comorbidities and tubal EP in the setting of severe symptomatic COVID-19 infection where all management options were precluded. Methods: Case report with literature review of management of tubal EP in the setting of severe symptomatic COVID-19 infection. Result: After careful consideration of options, the patient underwent successful medical management with methotrexate while receiving supportive care for COVID-19. Conclusions: Methotrexate proved to be the safest therapeutic option in this patient. Management of patients with severe COVID-19 and gynaecologic emergencies should be individualised and carefully reviewed with evolving knowledge of COVID-19.

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