Meningoencephalitis and optical neuritis caused by CRYPTOCOCCUS GATTII in an immunocompetent patient

The following case is of a 59-year-old man, undergoing no medication, with no pathological history or others risk factors, who presented dizziness, fever and asthenia twenty days before admission. The patient was admitted for investigation when the asthenia intensified, followed by seizures. On admission, blood count, biochemical tests and chest computed tomography were normal, a serological test for anti-HIV proved negative, while the magnetic resonance of the brain showed signs suggestive of meningoencephalitis. Cerebrospinal fluid (CSF) analysis suggested bacterial meningitis due to increased leukocytes with a predominance of polymorphonuclear cells, reduced glucose and increased proteins as well as positive Gram cocci in pairs by Gram and negative fungi by India ink test. Treatment with ceftriaxone was started. Since there was no significant improvement, CSF analysis was repeated on the seventh day of treatment. Intracranial pressure was measured by manometry (29 mmHg) and CSF analysis showed the presence of encapsulated yeasts similar to Cryptococcus neoformans by the India ink test. The treatment was modified to liposomal amphotericin B and flucytosine; the intracranial hypertension was controlled by repeated CSF punctures. After fourteen days of antifungal treatment, the patient presented visual turbidity and bilateral papillar edema, so corticosteroid therapy was prescribed. The evolution was favorable, with progressive resolution of symptoms, improvement of CSF parameters and visual acuity. The patient was discharged eight weeks after admission, with outpatient guidance. Corticosteroid therapy associated with antifungal therapy proved to be beneficial in this case, since following the introduction of corticosteroids there was progressive visual improvement.

A prevalence study of ocular manifestations in HIV positive patients on highly active anti-retroviral therapy

Background: Among 40 million cases worldwide, 50-75% of patients have at least one ocular manifestation in their lifetime. Many of ocular infections are treatable with therapeutic agents. Ocular manifestations invariably reflect systemic disease and can be the initial manifestations of HIV in many cases. Understanding of ocular sequel of HIV infection can lead to the early diagnosis and effective treatment. This study emphasizes on the need of developing a specific ophthalmic examination for the management of ocular manifestations in HIV infected patients.Methods: Cross sectional and observational study of 100 HIV positive participants on HAART were done irrespective of presence or absence of ocular symptoms. Participants were examined for complete ocular examination. Prevalence find out using chi-square test, find p values and ensuring statistical significance.Results: In our study, prevalence of ocular manifestation in HIV positive patients receiving HAART was 39%. Out of them, 20% adnexal involvement, 28% anterior segment involvement, 33% posterior segment involvement, 11% neuro-ophthalmic abnormality, 4% orbital involvement were present. 76% patients belonged to WHO clinical stage 2 and 3. 51% had CD4+ T cell counts <200 cells/µl.Conclusions: Posterior segment followed by anterior segment are the most commonly encountered ocular manifestations of HIV infection. Low CD4 count is good predictor for ocular manifestations in HIV positive patients. Higher WHO stage is also directly related with the severity of the ocular symptoms. Routine baseline ophthalmic screening to all HIV positive patients are necessary to prevent ocular morbidity.

Measurement of Contrast Sensitivity in Patients with Behçet's Disease without Ocular Involvement

PURPOSE: To evaluate contrast sensitivity in patients with Behçet's disease (BD) without ocular involvement. METHODS: The study group was composed of 47 BD patients (20 to 50 years of age) who did not have ocular involvement. The control group was composed of 47 normal volunteers who were similar to the study group in terms of age and gender. No participants in this study had any ocular or systemic pathologies except for BD. The contrast sensitivity measurements were performed using the Functional Acuity Contrast Test under photopic conditions, and the results were compared between the two groups. RESULTS: The mean age of the BD patients and control subjects was 34.5 ± 9.7 and 33.2 ± 7.6 years, respectively. The mean disease duration of the BD patients was 5.5 ± 6.4 years. There was a statistically significant decrease at five spatial frequencies (A, 1.5; B, 3; C, 6; D, 2; and E, 18 cycles per degree) in patients with BD compared with control subjects (p < 0.001, p = 0.004, p = 0.002, p < 0.001, and p = 0.001, respectively). CONCLUSIONS: The contrast sensitivity of BD patients without ocular involvement was lower than that of the control group. Further studies seem mandatory to confirm our results.

A Retrospective Analysis of Granulomatosis with Polyangiitis with Ocular Manifestations

PURPOSE: To analyze the treatment and prognosis of patients from our tertiary medical center with ocular and orbital involvement of granulomatosis with polyangiitis. METHODS: A retrospective analysis of the medical records of patients diagnosed with granulomatosis with polyangiitis that visited our single tertiary referral center from July 2008 to September 2014 was performed. RESULTS: A total of 51 patients diagnosed with granulomatosis with polyangiitis visited our center, and 21 of those patients had received an ophthalmologic examination. Of these, 9 patients (4 males, 5 females) had symptoms of the eye and orbit, and the clinical presentations were as follows: episcleritis, scleritis, marginal keratitis, orbital inflammation, orbital abscess, retinal vasculitis, and nasolacrimal duct obstruction. The patients each received treatments according to clinical presentation with topical, oral, or intravenous steroids or immunomodulatory agents such as cyclophosphamide. Nasolacrimal duct obstruction was treated with surgery in some cases. After an average follow-up period of 58 ± 30 months, all patients showed clinical improvement of their ocular and orbital involvement of granulomatosis with polyangiitis. CONCLUSIONS: Granulomatosis with polyangiitis is a relatively rare disease that sometimes has ocular or orbital involvement and can lead to blindness. Therefore, when ocular symptoms and signs present without a definitive cause, granulomatosis with polyangiitis must be ruled out, and appropriate treatment is needed. However, there are few published reports on the clinical presentation and prognosis of ocular and orbital involvement of granulomatosis with polyangiitis in Asians. This study showed that the incidence of ocular and orbital involvement in granulomatosis with polyangiitis was lower than previous reports.

A Retrospective Analysis of Granulomatosis with Polyangiitis with Ocular Manifestations

PURPOSE: To analyze the treatment and prognosis of patients from our tertiary medical center with ocular and orbital involvement of granulomatosis with polyangiitis. METHODS: A retrospective analysis of the medical records of patients diagnosed with granulomatosis with polyangiitis that visited our single tertiary referral center from July 2008 to September 2014 was performed. RESULTS: A total of 51 patients diagnosed with granulomatosis with polyangiitis visited our center, and 21 of those patients had received an ophthalmologic examination. Of these, 9 patients (4 males, 5 females) had symptoms of the eye and orbit, and the clinical presentations were as follows: episcleritis, scleritis, marginal keratitis, orbital inflammation, orbital abscess, retinal vasculitis, and nasolacrimal duct obstruction. The patients each received treatments according to clinical presentation with topical, oral, or intravenous steroids or immunomodulatory agents such as cyclophosphamide. Nasolacrimal duct obstruction was treated with surgery in some cases. After an average follow-up period of 58 ± 30 months, all patients showed clinical improvement of their ocular and orbital involvement of granulomatosis with polyangiitis. CONCLUSIONS: Granulomatosis with polyangiitis is a relatively rare disease that sometimes has ocular or orbital involvement and can lead to blindness. Therefore, when ocular symptoms and signs present without a definitive cause, granulomatosis with polyangiitis must be ruled out, and appropriate treatment is needed. However, there are few published reports on the clinical presentation and prognosis of ocular and orbital involvement of granulomatosis with polyangiitis in Asians. This study showed that the incidence of ocular and orbital involvement in granulomatosis with polyangiitis was lower than previous reports.

Utility of optical coherence tomography in a case of bilateral congenital macular coloboma.

Macular coloboma is a congenital defect of the retina and choroid in the macular region. It may appear due to an intrauterine inflammation or a developmental abnormality. Familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC) is a result of malformation of the renal tubule. Its combination with ocular manifestations may be genetic, specifically in case of claudin‑19 (CLDN‑19) gene mutations. The combination of FHHNC and ocular manifestations is not always present in these patients. Optical coherence tomography (OCT) helps us diagnose this condition by allowing us to evaluate and confirm the absence of retina layers without histological examination. Although genetic testing is necessary to diagnose mutational alterations of the CLDN‑19 gene, in our case, it was not necessary to diagnose the FHHNC patient with macular coloboma, since the diagnosis of ocular damage had been already accurately established by the OCT.

An unusual cause of optic neuritis: Rickettsiosis disease

Optic neuritis (ON) may be associated to a range of autoimmune or infectious diseases. We report herein a case of ON induced by Rickettsia conorii. A 53-year-old woman presented with a recent decrease in visual acuity and headache. ON was diagnosed on the basis of ophthalmologic examination and flash visual evoked potentials. Etiological investigation made in our department eliminated first autoimmune disorders (vasculitis and connective tissue diseases). Rickettsial optic neuritis was confirmed by detection of specific antibodies in serum and the negativity of other serologic tests. An association between corticosteroids and cyclines was prescribed with improvement of visual acuity.

An unusual cause of optic neuritis：rickettsiosis disease

Optic neuritis (ON) may be associated to a range of autoimmune or infectious diseases. We report herein a case of ON induced by Rickettsia conorii. A 53-year-old woman presented with a recent decrease in visual acuity and headache. ON was diagnosed on the basis of ophthalmologic examination and flash visual evoked potentials. Etiological investigation made in our department eliminated first autoimmune disorders (vasculitis and connective tissue diseases). Rickettsial optic neuritis was confirmed by detection of specific antibodies in serum and the negativity of other serologic tests. An association between corticosteroids and cyclines was prescribed with improvement of visual acuity.

Partial Unilateral Lentiginosis with an Ocular Involvement / 대한피부과학회지

Partial unilateral lentiginosis is a rare pigmentary disorder which is characterized by multiple grouped lentigines in unilateral or segmental distributions. The ocular involvement of the disease is extremely rare and only four cases have been reported until today. The exact pathophysiology is still unknown. An 18-year-old woman is being presented with unilateral hyperpigmented macules on her left forehead, eyelid, cheek, lip and chin which all demarcated sharply at the midline of her face. The lesion has been presented since the age of 1. Also, there are discrete brownish pigmentations on her left bulbar conjunctiva. Biopsy specimen is being obtained from the left chin and the histopathological examinations revealed increasing basal layer of pigmentations and mild elongation of rete ridges. The histopathological features are also consistent with lentigo simplex. Herein, we present a rare case of partial unilateral lentiginosis with an ocular involvement. We have also proposed that the partial unilateral lentiginosis has a possibility of ocular involvements.

Clinical spectrum of 15 patients with HIV-related ocular involvement in Tehran / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To determine the frequency of HIV-related ocular involvement and to describe the characteristics of involvement in a special clinic in Tehran.METHODS: In this cross sectional study, 141 patients (125 male and 16 female, 282 eyes) of HIV-infected patients with various stages of HIV infection that were referred to Center of behavioral diseases were evaluated during a period of 7 months. Every patient had a complete profile including demographic data, method of HIV transmission, recent CD4 T cell lymphocyte count, serological studies for common sexual or blood-born viruses and toxoplasmosis, history of antiretroviral therapy, and associated systemic disease. RESULTS: A total of 141 patients were evaluated. HIV-related ocular involvement was detected in 15 patients (10.6%), including 3 mycobacterium tuberculosis-related choroiditis, 2 cytomegalovirus retinitis, 2 retinal toxoplasmosis, 2 herpes simplex virus-related lesions, 1 HIV-associated retinopathy, 1 herpes zoster ophthalmicus, 1 undetermined vitritis, and 3 cases of cranial nerve involvement including 2 cases of gaze palsy and 1 case of papilitis. In our study, mean CD4 T cell lymphocyte count was fewer in patients with ocular involvement than in patients without ocular involvement (204.7±123.8 vs 403.7±339.7, P=0.029), but there was no difference in other possible associated factors between two groups.lesions are the most common HIV-related ocular involvements in Tehran that is different from those of recent publications in developed countries.

Ocular manifestations in Leigh syndrome / 소아과

PURPOSE: Leigh syndrome is a typical type of mitochondrial disease. This study was conducted to analyze the types of ophthalmologic symptoms and results of funduscopy conducted in the ophthalmologic examination of patients with Leigh syndrome. METHODS: Funduscopy was conducted on 24 subjects, who were chosen among those diagnosed as having mitochondrial respiratory chain complex defect and who were clinically suitable for the criteria of Leigh syndrome. Their clinical features, ophthalmologic symptoms, and ophthalmologic examination results were retrospectively analyzed. RESULTS: Of the 24 patients with Leigh syndrome, 11 developed ophthalmologic symptoms and no abnormal finding was observed in 13. The most frequent abnormal finding was visual disturbance in 5 patients. Funduscopy revealed abnormal findings in 17 patients; retinal pigmentation was the most frequent abnormality and was seen in 9 patients. CONCLUSION: Funduscopy can be an important screening test to find ophthalmologic abnormalities among patients with mitochondrial disease (MD), including those patients whose ophthalmologic symptoms are inconspicuous. It is predicted that an improved screening test can be made in the future that will identify risk factors related to ophthalmologic symptoms.

Lagochilascariasis leading to severe involvement of ocular globes, ears and meninges / Infecção humana por Lagochilascaris minor com envolvimento ocular, auditivo e das meninges

A case report of a 31 year-old woman from Paraíba State (North-Eastern Brazil) that presented severe involvement of ocular globes, ears and meninges. Diagnosis was established after enucleation of her left eye, when adult worms were seen in the midst of a granulomatous inflammatory process. Her response to the initial treatment with levamisole and cambendazole was good, but there was a relapse after the fifth month of treatment even with maintenance doses of both medications. She later received ivermectin and albendazol and responded well.

Paciente do sexo feminino, com 31 anos, procedente da Paraíba, apresentava envolvimento severo de ambos os globos oculares, com perda da visão à esquerda, comprometimento da audição e das meninges. Após enucleação do olho esquerdo fragmento de helminto identificado como Lagochilascaris minor foi observado em processo inflamatório granulomatoso. Inicialmente a paciente foi tratada com levamisol e cambendazol, com bom resultado. Verificou-se, todavia, piora do quadro após cinco meses, com eliminação de larvas do ascarídeo em lesão presente na órbita esquerda, embora a medicação fosse mantida com administração periódica. Houve boa resposta terapêutica, com regressão do quadro, após substituição dos anti-helmínticos anteriores pela associação ivermectina e albendazol.