Résumé
Candida is the most common etiologic agent causing endogenous endophthalmitis resulting due to hematogenous spread from a remote primary focus. Risk factors for the infection include intravenous drug use, hyperalimentation, surgery, malignancy, diabetes, neutropenia, and the use of broad- spectrum antibiotics and immunosuppressive agents, especially corticosteroids. The outcome of candida endophthalmitis is disappointing. One main problem in the management of this infection is that early diagnosis is difficult. Thus, treatment may be delayed and this which often leads to a poor outcome. Candida endophthalmitis, particularly candida guilliermondii endophthalmitis, is extremely rare, although it is becoming more common as the number of chronically debilitated patients and the use of invasive procedures increase. It is an ophthalmologic emergency and commonly takes a tragic course. Therefore, early suspicion and aggressive management are imperative to prevent visual loss. The authors report a case of candida endophthalmitis caused by Candida guilliermondii in a 65-year-old man with mixed gastrointestinal stromal tumor(GIST) and stomach adenocarcinoma.
Sujets)
Sujet âgé , Humains , Adénocarcinome , Hormones corticosurrénaliennes , Antibactériens , Candida , Diagnostic précoce , Urgences , Endophtalmie , Tumeurs stromales gastro-intestinales , Immunosuppresseurs , Neutropénie , Facteurs de risque , EstomacRésumé
Candida is the most common etiologic agent causing endogenous endophthalmitis resulting due to hematogenous spread from a remote primary focus. Risk factors for the infection include intravenous drug use, hyperalimentation, surgery, malignancy, diabetes, neutropenia, and the use of broad- spectrum antibiotics and immunosuppressive agents, especially corticosteroids. The outcome of candida endophthalmitis is disappointing. One main problem in the management of this infection is that early diagnosis is difficult. Thus, treatment may be delayed and this which often leads to a poor outcome. Candida endophthalmitis, particularly candida guilliermondii endophthalmitis, is extremely rare, although it is becoming more common as the number of chronically debilitated patients and the use of invasive procedures increase. It is an ophthalmologic emergency and commonly takes a tragic course. Therefore, early suspicion and aggressive management are imperative to prevent visual loss. The authors report a case of candida endophthalmitis caused by Candida guilliermondii in a 65-year-old man with mixed gastrointestinal stromal tumor(GIST) and stomach adenocarcinoma.
Sujets)
Sujet âgé , Humains , Adénocarcinome , Hormones corticosurrénaliennes , Antibactériens , Candida , Diagnostic précoce , Urgences , Endophtalmie , Tumeurs stromales gastro-intestinales , Immunosuppresseurs , Neutropénie , Facteurs de risque , EstomacRésumé
In systemic lupus erythematosus (SLE), besides immunosuppressive therapy, the immunological abnormalities such as impaired phagocytosis and deficiency of cell-mediated immunity contribute to the increased risk of infection. Most of all, the incidence of tuberculous infection is higher and the pattern tends to be more extensive and extrapulmonary than in general population. Therefore the contributory role of tuberculous infection in mortality of SLE should be emphasized, especially in areas endemic for Mycobacterium tuberculosis like Korea. When tuberculous infection involves central nervous system, it can mimic lupus myelitis, showing the clinical manifestations like paraplegia, sensory impairment and bladder dysfunction. Tuberculous myelitis should be differentiated with lupus myelitis as early as possible for proper treatment and better prognosis. We report a 52 year-old woman with SLE presented with paraplegia and urinary incontinence, who were initially suspected as lupus myelitis. But the AFB smear and culture of cerebrospinal fluid were compatible with tuberculosis myelitis.
Sujets)
Femelle , Humains , Adulte d'âge moyen , Système nerveux central , Liquide cérébrospinal , Immunité cellulaire , Incidence , Corée , Lupus érythémateux disséminé , Mortalité , Mycobacterium tuberculosis , Myélite , Paraplégie , Phagocytose , Pronostic , Tuberculose , Vessie urinaire , Incontinence urinaireRésumé
BACKGROUND: One of the groups with highest risk for avascular necrosis is patient with systemic lupus erythematosus (SLE). Corticosteroid therapy is also the most important risk factor. No predictive test, however, was known to detect avascular necrosis. The purpose of this study is to evaluate hemodynamic flow to the proximal femur in patients with SLE with long term corticosteroid therapy. METHODS: Twenty-two patients with SLE without avascular necrosis and with long-term corticosteroid treatment (mean months; 41 (1-156)) versus 15 healthy controls were evaluated. Medial and lateral circumflex arteries of 44 hips in 22 SLE patients and 30 hips in healthy controls were examined using ultrasoud equipment with color Doppler and power Doppler capability. Arterial pulstality index (PI) and peak systolic velocity (PSV) were determined with neutral and internal rotation position (stimulated ischemia). RESULTS: PSV was significantly increased in patients with SLE than healthy controls (70.6+/-40.4 vs 46.9+/-19.3; p<0.001) with neutral position as well as (74.8+/-42.3 vs 49.9+/-19.9; p<0.001) with internal rotation. PI was also higher in SLE patients than healthy controls (8.9+/-6.3 vs 5.5+/-3.4; p<0.001) with neutral position as well as (8.1+/-7.1 vs 3.9+/-2.5; p<0.001) with internal rotation. PI strongly correlated with PSV (r=0.99, p<0.001). But PSV or PI did not correlate with duration of corticosteroid use. CONCLUSION: Peak systolic velocity and pulstality index of arteries to the femur head in patients with SLE with long-term corticosteroid treatment were significantly higher than healthy controls. These hemodynamic changes may contribute to develop avascular necrosis of the hip in patients with SLE.
Sujets)
Humains , Artères , Tête du fémur , Fémur , Hémodynamique , Hanche , Lupus érythémateux disséminé , Nécrose , Ostéonécrose , Facteurs de risque , ÉchographieRésumé
No abstract available.