scholarly journals A case report of disseminated nocardiosis with ocular involvement in myasthenia gravis patient and literature review

2019 ◽  
Author(s):  
shuhui wang ◽  
Bin Jiang ◽  
Yao Li ◽  
Yanchang Shang ◽  
Zhengshan Liu ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Myasthenia Gravis ◽  
Potential Risk ◽  
Immunosuppressive Agents ◽  
Ocular Involvement ◽  
Immunocompromised Patients ◽  
Case Presentation ◽  
Ocular Manifestations ◽  
Life Threatening ◽  
Disseminated Nocardiosis

Abstract Background Nocardiosis is a rare and life-threatening opportunistic infection in the immunocompromised patients. Myasthenia gravis (MG) patients have the potential risk of nocardia infection because of the use of immunosuppressive agents. To date, only 7 cases of patients with MG have been reported to have nocardiosis. Disseminated nocardiosis with ocular involvement in MG patient haven’t been reported. Case presentation A 66-year-old man with MG, receiving treatment of methylprednisolone and azathioprine, was found to have respiratory infection. He also had heterogeneous symptoms with skin, brain and ocular manifestations. Nocardia bacteria was verified by the culture of puncture fluid, and the diagnosis of disseminated nocardiosis was made. Except for the left eye blindness, the patient completely recovered from the disease with combination antibiotic therapy. To further understand nocardiosis in patients with MG, we reviewed previous relevant literatures. According to all the literatures, this is the first report of disseminated nocardiosis with ocular involvement in MG patient. Conclusions MG patients with immunosuppressant treatments have the potential risk of rare nocardia infection, and a favourable prognosis can be achieved through early diagnosis and appropriate antibiotic therapy.

scholarly journals A case report of disseminated nocardiosis with ocular involvement in a myasthenia gravis patient and literature review

2019 ◽  
Author(s):  
shuhui wang ◽  
Bin Jiang ◽  
Yao Li ◽  
Yanchang Shang ◽  
Zhengshan Liu ◽  
...  
Keyword(s):  
At Risk ◽  
Antibiotic Therapy ◽  
Myasthenia Gravis ◽  
Relevant Literature ◽  
Immunosuppressive Agents ◽  
Ocular Involvement ◽  
Case Presentation ◽  
Ocular Manifestations ◽  
Life Threatening ◽  
Disseminated Nocardiosis

Abstract Background Nocardiosis is a rare and life-threatening opportunistic infection in immunocompromised patients. Myasthenia gravis (MG) patients are potentially at risk of nocardia infection because of the use of immunosuppressive agents. To date, only 7 patients with MG have been reported to have nocardiosis. Disseminated nocardiosis with ocular involvement has not been reported in MG patients. Case presentation A 66-year-old man with MG who was receiving treatment with methylprednisolone and azathioprine was found to have a respiratory infection. He also had heterogeneous symptoms with skin, brain and ocular manifestations. Nocardia bacteria verified by the culture of puncture fluid, and a diagnosis of disseminated nocardiosis was made. Except for left eye blindness, the patient completely recovered from the disease with combination antibiotic therapy. To further understand nocardiosis in patients with MG, we reviewed the previous relevant literature. According to the literature, this is the first report of disseminated nocardiosis with ocular involvement in an MG patient. Conclusions MG patients with immunosuppressant treatments are potentially at risk of a rare nocardia infection, and a favourable prognosis can be achieved through early diagnosis and appropriate antibiotic therapy.

scholarly journals A case report of disseminated nocardiosis with ocular involvement in a myasthenia gravis patient and literature review

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Shuhui Wang ◽  
Bin Jiang ◽  
Yao Li ◽  
Yanchang Shang ◽  
Zhengshan Liu ◽  
...  
Keyword(s):  
At Risk ◽  
Antibiotic Therapy ◽  
Myasthenia Gravis ◽  
Relevant Literature ◽  
Immunosuppressive Agents ◽  
Ocular Involvement ◽  
Case Presentation ◽  
Ocular Manifestations ◽  
Life Threatening ◽  
Disseminated Nocardiosis

Abstract Background Nocardiosis is a rare and life-threatening opportunistic infection in immunocompromised patients. Myasthenia gravis (MG) patients are potentially at risk of nocardia infection because of the use of immunosuppressive agents. To date, only 7 patients with MG have been reported to have nocardiosis. Disseminated nocardiosis with ocular involvement has not been reported in MG patients. Case presentation A 66-year-old man with MG who was receiving treatment with methylprednisolone and azathioprine was found to have a respiratory infection. He also had heterogeneous symptoms with skin, brain and ocular manifestations. Nocardia bacteria verified by the culture of puncture fluid, and a diagnosis of disseminated nocardiosis was made. Except for left eye blindness, the patient completely recovered from the disease with combination antibiotic therapy. To further understand nocardiosis in patients with MG, we reviewed the previous relevant literature. According to the literature, this is the first report of disseminated nocardiosis with ocular involvement in an MG patient. Conclusions MG patients with immunosuppressant treatments are potentially at risk of a rare nocardia infection, and a favourable prognosis can be achieved through early diagnosis and appropriate antibiotic therapy.

scholarly journals Ocular Manifestations of Biopsy-Proven Pulmonary Sarcoidosis in Korea

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Seung Yong Choi ◽  
Jae Hoon Lee ◽  
Jae-Yon Won ◽  
Jeong Ah Shin ◽  
Young-Hoon Park
Keyword(s):  
Clinical Features ◽  
Systemic Treatment ◽  
Pulmonary Function Tests ◽  
Immunosuppressive Agents ◽  
Immunosuppressive Treatment ◽  
Pulmonary Sarcoidosis ◽  
Ocular Involvement ◽  
Treatment Rate ◽  
Ocular Manifestations ◽  
Systemic Treatments

Purpose. To investigate the clinical features and ocular manifestations of biopsy-proven pulmonary sarcoidosis in Korea. Methods. 55 patients diagnosed with pulmonary sarcoidosis by bronchoscopic or excisional biopsy were included. By retrospective clinical chart review, we investigated features of uveitis, ocular and systemic treatments, visual acuity, angiotensin-converting enzyme level, chest radiography, and pulmonary function tests. Clinical features were analyzed by presence of uveitis, site of biopsy, and first manifested sign of sarcoidosis. Results. The group with uveitis (n=39) presented with higher systemic (71.8%) and immunosuppressive treatment rates (35.9%) than the group without uveitis (31.3%, 0%, resp.) (P=0.007, P=0.005, resp.). There were no significant differences in clinical features, including systemic treatment rate, by type of biopsy. Of 39 patients with uveitis, the group with ocular manifestation as a first sign of sarcoidosis showed higher systemic and immunosuppressive treatment rates (88.9%, 55.6%) compared to the group with pulmonary manifestation as a first sign (57.1%, 19.0%) (P=0.037, P=0.018, resp.). Conclusions. In patients with biopsy-proven pulmonary sarcoidosis, the presence of ocular involvement and uveitis as a first sign could be significant factors associated with higher systemic treatment rate, especially with immunosuppressive agents. Biopsy site determined by location and size had no influence on clinical features.

scholarly journals Bronchiolitis obliterans following toxic epidermal necrolysis: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Ujjwal Prakash Khanal ◽  
Akash Roy ◽  
Arun Kumar Sharma
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Bronchiolitis Obliterans ◽  
Clinical Course ◽  
Supportive Therapy ◽  
Skin Condition ◽  
Pulmonary Complications ◽  
Drug Induced ◽  
Case Presentation ◽  
Ocular Manifestations ◽  
Life Threatening

Abstract Background Toxic epidermal necrolysis (TEN) is a rare, acute and potentially fatal skin condition usually induced by drugs. Although much attention is focused on the life threatening acute cutaneous and sight threatening ocular manifestations of this disease, chronic pulmonary complications like bronchiolitis obliterans are occasionally encountered. However, little is known about its incidence, pathogenesis, clinical course and outcome in children recovering from TEN. Case presentation We report a five-year-old boy who presented four months after the first manifestation of drug-induced TEN with cough and shortness of breath and was subsequently diagnosed with bronchiolitis obliterans. He was treated with supportive therapy that improved his hypercapnia allowing him to be discharged on domiciliary oxygen, chest physiotherapy and bronchodilators. Conclusions This case highlights the need to be vigilant for adverse drug reactions and consider chronic pulmonary complications like Bronchiolitis Obliterans in children recovering from TEN.

Ocular Manifestations In Late Onset Behçet’s Disease

2020 ◽  
Vol 13 ◽  
Author(s):  
Saadouli D ◽  
Ben Mansour K ◽  
Yahyaoui S ◽  
El Afrit N ◽  
Lahmar A ◽  
...  
Keyword(s):  
Behçet’S Disease ◽  
Behcet’S Disease ◽  
Oral Corticosteroid ◽  
Behçet's Disease ◽  
Late Onset ◽  
Immunosuppressive Agents ◽  
Posterior Uveitis ◽  
Ocular Involvement ◽  
Behcet's Disease ◽  
Ocular Manifestations

Background: Behçet’s disease is frequent in Tunisia and potentially serious which it can endanger both the vital and visual prognosis. Late occurrence of the disease is uncommon and less frequently investigated. Aims: The aim of this study was to analyse the demographic characteristics and ocular manifestations of patients with late-onset Behçet disease in Tunisia, North Africa. Methods: A retrospective study was performed on 38 eyes of 21 oculo-Behçet patients over a seven-year period. Results: The mean age of our patients was 54.81 years. The sex ratio M/F was 2.5. The period between onset of the first symptom and diagnosis of Behçet’s disease varied from 3 days to 2 years. The primary complaint was decrease of visual acuity reported in 8 patients. Ocular involvement was revealing of Behçet’s disease in 2 patients, bilateral in 17 patients and active in 31 eyes. The ocular manifestations in late-onset Behçet’s disease were dominated by uveal involvement (30 eyes). The most frequent form of uveitis was panuveitis noted in 13 eyes. Ocular complications were dominated by macular involvement in 8 patients (14 eyes). Blindness was noted in 4 eyes of 4 patients (10.5%). Topical corticosteroids were used in 30 eyes. Three patients were treated only with oral corticosteroid and 9 patients with a combination of oral corticosteroid and immunosuppressive agents. Conclusion: Since the course of the ocular involvement in late-onset Behçet’s disease is regarded to be relatively mild, it is noteworthy that our study revealed that blindness was noted in 10,5% and posterior uveitis and panuveitis were the most common uveal lesion.

scholarly journals Retinal involvement in acute thrombotic thrombocytopenic purpura: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
A. G. N. M. K. Bandara ◽  
Anne Thushara Matthias
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
Ophthalmological Examination ◽  
Cotton Wool ◽  
Thrombocytopenic Purpura ◽  
Case Presentation ◽  
Ocular Manifestations ◽  
Cotton Wool Spots ◽  
Life Threatening ◽  
History Of ◽  
Nonspecific Sign

Abstract Background Thrombotic thrombocytopenic purpura (TTP) is a life-threatening hematological condition associated with deficiency in ADAMTS13. Ocular manifestations associated with TTP are uncommon. Case presentation Here we report a case where a 44 year old female patient with a history of symptomatic anemia and cotton wool appearance in retina during ophthalmological examination and subsequently, she was diagnosed to have TTP. The proper management with Therapeutic Plasma Exchange (TPE) and IV methylprednisolone improved the condition of the patient markedly. Conclusion It concludes that even though the presence of cotton wool appearance in retina is a nonspecific sign it needs to be properly evaluated as there can be underlying serious illnesses as in our patient. Cotton wool spots can be an early sign of underlying retinal compromise and it should be identified early.

scholarly journals A rare case of nivolumab-related myasthenia gravis and myocarditis in a patient with metastatic gastric cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masaru Komatsu ◽  
Motoharu Hirai ◽  
Kazuaki Kobayashi ◽  
Hideki Hashidate ◽  
Junki Fukumoto ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adverse Effects ◽  
Myasthenia Gravis ◽  
Metastatic Gastric Cancer ◽  
Myocardial Biopsy ◽  
Case Presentation ◽  
Antibody Positivity ◽  
Life Threatening ◽  
Gastric Cancer Treatment ◽  
Anti Acetylcholine

Abstract Background Although rare, several immune-related adverse effects can be life-threatening. Here, we describe a metastatic gastric cancer patient presenting with nivolumab-related myasthenia gravis and myocarditis, a previously unreported adverse effect of gastric cancer treatment. Case presentation A 66-year-old man with metastatic gastric cancer visited the emergency department because of dizziness after the first dose of nivolumab. Diagnoses of nivolumab-related myasthenia gravis and myocarditis were established. Myocardial biopsy results and anti-acetylcholine receptor antibody positivity confirmed the diagnoses. Despite plasma exchange and intravenous methylprednisolone and immunoglobulin administration, the patient’s general condition gradually worsened, and he died. Conclusions Strict monitoring for cardiac and neuromuscular symptoms after nivolumab administration is necessary to rapidly treat these adverse effects.

scholarly journals Myasthenia Gravis – Exacerbation and Crisis

2018 ◽  
Vol 02 (01) ◽  
pp. E10-E15
Author(s):  
Michael Schroeter ◽  
Günther Thayssen ◽  
Julia Kaiser
Keyword(s):  
Myasthenia Gravis ◽  
Immunosuppressive Agents ◽  
Antibody Therapy ◽  
Myasthenic Crisis ◽  
Timely Manner ◽  
Highly Active ◽  
Threatening Condition ◽  
Life Threatening ◽  
Management Of Dysphagia ◽  
Reasonable Use

AbstractMyasthenic exacerbation and crisis are most critical incidences in myasthenia gravis. Even nowadays myasthenic crisis is a life-threatening condition, with a lethality of 2–3%. We review means of avoiding myasthenic exacerbation and crisis, elaborate on red flags and how to establish highly-active therapy in a timely manner. This includes the reasonable use of cholinesterase inhibitors, immunoadsorption or plasma exchange, as well as immunoglobulins and steroids. Immunosuppressive agents and monoclonal antibody therapy add to the therapeutic options.Intensive care of myasthenic patients includes the management of dysphagia and delirium. Importantly, the perioperative management of patients undergoing thymectomy and weaning are specific challenges in the treatment of myasthenic patients in the ICU.Establishing timely consequent immunosuppression and treatment of myasthenic patients in specialized outpatient centres help to avoid repetitive exacerbations and crises.

scholarly journals Perforation of the atrial wall and aortic sinus after closure of an atrial septal defect with an Atriasept occluder: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zai-Qiang Zhang ◽  
Jia-Wang Ding
Keyword(s):  
Case Report ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Emergency Operation ◽  
Atrial Wall ◽  
Aortic Sinus ◽  
Case Presentation ◽  
Lethal Complications ◽  
Life Threatening

Abstract Background While the perforation of the atrial wall and aortic sinus after closure of an atrial septal defect (ASD) is rare, it’s life-threatening, with rapid progress and high mortality. To the best of our knowledge, 21 similar cases have been reported since 1976. Case presentation We report a 16-year-old male whose atrial septal defect (ASD) was closed using a 12-mm Amplatzer septal occluder (ASO). Atrial wall and aortic sinus perforation occurred 3 months after transcatheter closure, and the patient was discharged after emergency operation. He was discharged on the 12th postoperative day in good overall condition. Conclusions With this case report, we want to illustrate that although percutaneous closure of ASD is regarded as a routine procedure, we should not forget the potentially lethal complications, especially cardiac erosion. Therefore, we should carefully evaluate the risk of erosion before surgery, and careful lifelong follow-up is needed.

scholarly journals “Old wine in a new bottle” - post COVID-19 infection, central serous chorioretinopathy and the steroids

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Srinivasan Sanjay ◽  
Poornachandra B. Gowda ◽  
Bhimasena Rao ◽  
Deepashri Mutalik ◽  
Padmamalini Mahendradas ◽  
...  
Keyword(s):  
Virus Disease ◽  
Anterior Segment ◽  
Central Serous Retinopathy ◽  
Oral Antibiotics ◽  
Rt Pcr ◽  
Case Presentation ◽  
Ocular Manifestations ◽  
Corrected Distance Visual Acuity ◽  
History Of ◽  
The Right

Abstract Introduction Corona virus disease (COVID-19) pandemic can cause myriad of ocular manifestations. We report a case of unilateral multi focal central serous retinopathy, post COVID-19 infection in an Asian Indian female. Case presentation A 42-year-old female presented to us with unilateral blurring, in the right eye (OD), 12 days after COVID-19 infection. She had fever, chills, shortness of breath and cough with tiredness and was COVID- RT PCR positive. She was administered intravenous and oral antibiotics with injection heparin/remdesivir, during her 7 day stay at the hospital. She was also on steroid inhalers. She had no systemic history of note. On ocular evaluation, her corrected distance visual acuity was 20/40 in OD and 20/20 in left eye (OS). Anterior segment was normal. Anterior vitreous was clear. Fundus examination of the OD showed central serous retinopathy (CSCR) with OS being normal. Conclusion CSCR can occur post COVID-19 due to steroid administration and physicians administering it should be aware of this and refer the patients to an ophthalmologist earlier.

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