Hoagland Sign as an Aid for Antimicrobial Stewardship—A Case Report

Hoagland sign is an early and transient bilateral painless upper eyelid edema observed in patients with Epstein-Barr virus (EBV)-related infectious mononucleosis. This sign can predate the appearance of exudative pharyngitis and cervical lymphadenopathy. Usually, this sign disappears by first week of infection. Here, we describe the occurrence of late onset Hoagland sign in a 14-year old boy who presented to us on 10th day of fever. Hoagland sign appeared after 10 days from symptom onset in our patient. Despite persistence of fever, the presence of Hoagland sign which appeared prior to confirmation of EBV infection was a helpful indicator for stopping antibiotics. In view of tonsillar hypertrophy with potential airway compromise and biochemical parameters suggestive of possible secondary hemophagocytic lymphohistiocytosis, he was initiated on steroids with which defervescence and prompt resolution of symptoms occurred. EBV can present as acute undifferentiated febrile syndrome which might result in inappropriate use of antibiotics. This case highlights the importance of using clinical clues like Hoagland sign to optimize antimicrobial stewardship.

A new case of scalp angiosarcoma revealed by eyelid edema

Cutaneous angiosarcoma is a rare and highly aggressive neoplasm with poor prognosis. Owing to its variable presentation, it may be a challenging clinical and histological diagnosis. Herein, we describe a particular case of cutaneous angiosarcoma of the head and neck in a 71-year-old male with skin type V who presented with solid, progressive eyelid edema. A histological examination of skin biopsies first concluded cutaneous metastasis of an undifferentiated carcinomatous tumor. Immunostaining was essential to reach the correct diagnosis. The treatment of cutaneous angiosarcoma remains unsatisfactory. We sincerely hope that the prognosis of cutaneous angiosarcoma will be improved with the use of targeted therapies based on current genetic studies as it has been for melanoma.

Vitreous hemorrhage: A rare ophthalmic adverse effect due to imatinib treatment

Introduction Imatinib is generally well tolerated by patients. The most common ophthalmic side effects are eyelid edema and periorbital edema. Other side effects which occur at rates of <1% include blepharitis, blurred vision, conjunctival hemorrhage, conjunctivitis, retinal hemorrhage, etc. An uncommon case is here reported of a 51-year-old male with chronic myeloid leukemia who developed vitreous hemorrhage due to imatinib after 9 months of treatment. Case report A 51-year-old male with leukocytosis detected in the blood test examination was referred to the Hematology Department. The bone marrow biopsy result was compatible with chronic myeloid leukemia. Imatinib treatment (400 mg/day) was started. In the ninth month of imatinib treatment, the patient complained of a sudden decrease in vision. Vitreous hemorrhage was detected in the left eye and the patient underwent surgery. Vitreous hemorrhage recurred 1 month after the operation. On the fourth day after the discontinuation of imatinib treatment, the patient's ophthalmic complaints improved significantly. The Naranjo algorithm was applied and a score of 9 was detected. The vitreous hemorrhage of the patient was attributed to imatinib, and so the treatment of the patient was switched to bosutinib. Discussion Imatinib is an oral signal inhibitor that targets tyrosine kinase for BCR/ABL, platelet-derived growth factor, stem cell factor, and c-kit (CD117). The conjunctiva and sclera have a large amount of c-kit positive mast cells which are inhibited by imatinib. The inhibition of c-kit positive mast cells by imatinib may be responsible for further exposure of the conjunctival mucosa to injuries.

A Case Study of Eyelid Edema Post Craniotomy

Objectives: This study considered the effectiveness of Korean medicine for the treatment of eyelid edema post craniotomy.Methods: The patient was diagnosed with Taeumin-one of the four constitution types in Korean medicine-and treated with herbal medicines: Cheongsimyeunja-tang, Chungpyesagan-tang, and Hwangryunhaedok-tang pharmacoacupuncture treatment. The severity of eyelid edema was assessed using Kara and Gokalan’s scale, daily imaging of the patient’s eyelids, and the ratio of the length of the left eye to that of the right.Results: Following treatment, the Kara and Gokalan score decreased from 3 to 0. The changes in the ratios were 29% and 50%, respectively. The visual field defect due to edema in the left eye was also repaired.Conclusion: This study suggests that Korean medical treatment could be an effective option for treating eyelid edema following craniotomy.

Identification of SARS-CoV-2 on the ocular surface in a cohort of COVID-19 patients from Brazil

In this cross-sectional study, we investigate the presence of Severe Acute Respiratory Syndrome Coronavirus 2 Ribonucleic Acid (SARS-CoV-2 RNA) in the tears of hospitalized COVID-19 patients. After laboratory confirmation of SARS-CoV-2 infection by reverse transcription polymerase chain reaction (RT-PCR) analysis, tear samples from both eyes of each patient were collected using conjunctival swab for RT-PCR. Detailed demographic profile, systemic and ocular symptoms, comorbidities, clinical, ancillary, and ocular manifestations were evaluated. Of the 83 patients enrolled in the study, 7 (8.43%) had SARS-CoV-2 RNA detected in the tear samples. Neutrophils’ count, C-reactive protein, and D-dimer were higher in patients with SARS-CoV-2 detected in tears than in patients without virus in ocular surface samples. One patient with SARS-CoV-2 in tears showed mild ocular eyelid edema, hyperemia, and chemosis. No relevant ocular manifestations were detected in the other patients. Although the levels of viral RNA on ocular surface samples were low for most patients (5/7), with positivity only for gene N and CT higher than 30, two patients were positive for all viral targets tested ( N, E, and RpRd), with viral load near 1 × 105 ePFU/mL, indicating that the ocular transmission of SARS-CoV-2 is a possibility that needs to be considered, especially in the hospital environment. Further studies need to be conducted to demonstrate whether infective viral particles could be isolated from tears.

Characteristics of changes in the structures of the anterior eye of rabbits at acute opisthorchosis and paracoenogonymosis

The purpose of the research is studying changes in the structures of the anterior eye of rabbits at acute opisthorchosis and paracoenogonymosis in experiment.Materials and methods. The studies were performed on sexually mature male rabbits. The first group consisted of animals infected with 50 metacercariae Opisthorhis felineus (Rivolta, 1884) (n = 3), and the second consisted of animals infected with 50 metacercariae Paracoenogonimus ovatus (Katsurada, 1914) (n = 3). The animals from the third group were control (n = 3). The study at opisthorchosis was performed at 1, 2, 3, 4 and 5 weeks after infection, and the study at paracoenogonymosis was only performed at 1 and 2 weeks in connection with rapidly proceeding infection. These groups were compared within 1 and 2 weeks and according to specific changes. The clinical study included the upper and lower eyelids turned outwards in animals, and examination of the conjunctival surface of the eyelids, epicanthus (third eyelid), cornea, limbus and sclera of the eyeball, and eyelash less edge of the eyelids at all periods of observation. The measurements were carried out with a millimeter ruler along the longest part of the formation. The data were processed statistically by calculating the arithmetic mean (M) with the standard error of mean (σ) using the Microsoft Excel 2007 software package, and changes in characteristics were assessed at follow-up by the Wilcoxon rank sum test.Results and discussion. In the acute phase of opisthorchosis, the structures of the anterior eye are damaged, which occurs after the first week of infection in the form of allergic conjunctivitis, episcleritis. We found follicular formations in the upper eyelid, in the outer corner of the eye with further synulosis by the 5th week, and vascular enhancement of the upper eyelid. Conjunctival and corneal changes a month later were of the type of trachomatous pannus with conjunctival hyperemia of both eyelids, edema, and reddening of the free eyelash less edge. The infection by P. ovatus showed no follicular formations or eyelid edema for two weeks. Thus, at opisthorchosis, we observed the phenomena of combined pathology of the visual organ with a specific component for which an independent name can be distinguished, specific parasite-associated ophthalmitis.

TOXICITY OF THE DRUG DELCID 7.5® WHEN APPLIED TO THE MUCOUS MEMBRANES

The effect of the drug Delcid 7.5® on the mucous membranes of the eyes of rabbits of the Australian White breed, weighing 2–3 kg, which were instilled in the conjunctival cavity of the right eye with 1 drop of the drug. The left eye was a control eye, and distilled water was instilled into it. The studies were conducted according to the score system, based on the total score (according to the classification of A. Majda, K. Chrusaieleska, 1973) according to the following criteria: conjunctival and corneal hyperemia, eyelid edema, discharge at a drug concentration, 10% the degree of severity of the effect in rabbits is weak, at a concentration of 50% – moderate. Experience has shown that a single instillation of the drug Delcid 7.5® into the conjunctival sac at a concentration of 10% does not cause a response, and a 50% concentration causes a moderately irritating effect of the drug on the mucous membranes. The results of the conducted studies show that the insectoacaricidal drug Delcid 7.5® for veterinary use, developed by LLC "NVC Agrovetzashchita", including deltamethrin, piperonyl butoxide, diflubenzuron is safe for rabbits, and therefore it can be recommended for studying the effectiveness of acarosis in rabbits and other animal species.