Behcet's uveitis

Behcet's disease is a multisystem inflammatory disorder that is most common in countries along the ancient "Silk Road". The eye is the most commonly involved vital organ in Behcet's patients and the typical form of involvement is a relapsing remitting panuveitis and retinal vasculitis. Uveitis is the initial manifestation of the disease in 10-15% of the patients. Anterior uveitis is always nongranulomatous. Diffuse vitritis, retinal infiltrates, sheathing of predominantly retinal veins, and occlusive vasculitis are the typical signs of posterior segment inflammation. Spontaneous resolution of acute inflammatory signs is a diagnostic feature. Fundus fluorescein angiography is the gold standard in monitoring inflammatory activity. Laser flare photometry is a useful noninvasive tool since flare readings correlate with fluorescein angiographic leakage. The most common complications are cataract, maculopathy, and optic atrophy. Male patients have a more severe disease course and worse visual prognosis. Immunomodulatory therapy is indicated in all patients witih posterior segment involvement. Corticosteroids combined with azathioprine and/or cyclosporine is used initially. Biologic agents, including interferon alfa and infliximab, are used in resistant cases. Visual prognosis has improved in recent years with an earlier and more aggressive use of immunomodulatory therapy and the use of biologic agents in resistant cases

Principales causas de uveítis en pacientes infectados con el virus de la inmunodeficiencia humana / The most frequent causes of uveitis in patients infected with the human immunodeficiency virus

Se estudiaron 27 pacientes infectados con el virus de la inmunodeficiencia humana (VIH) evaluados en la Clínica de Uveítis de la Asociación para Evitar la Ceguera en México en el periodo comprendido entre enero de 1984 y enero de 1995, con objeto de conocer las causas más frecuentes de uveítis en este grupo de pacientes. Todos los paciente estudiados fueron hombres con un rango de edad de 24-44 años. La homosexualidad fue el principal factor de riesgo en 15 pacientes (56 por ciento). Veintiseis pacientes (96.2 por ciento) presentaban o habían presentado antes de la afección ocular alguna manifestación sistémica de enfermedades asociadas a la infección por VIH. El motivo de consulta más frecuente fue la disminución de la agudez visual en 18 pacientes (66.7 por ciento). La retinitis por citomegalovirus (CMV) fue la principal causa de uveítis (47 por ciento) seguida de las panuveítis por sífilis y toxoplasmosis(14 por ciento).

Bilateral panuveitis as a presentation of the sero-negative stage of HIV infection

We described the clinical picture of the eyes together with the laboratory findings of an African adolescent during the sero-negative stage of HIV infection who presented clinically with bilateral panuveitis with mild reaction in both the anterior chamber and vitreous. The fundus showed plaques that could be cotton-wool spots and pigmentary changes. Based on the presence of eosinophilia, a drop T-helper / T-suppressor together with a drop of B-cell total number, absent delayed hypersensitivity together with multiple opportunistic infections in the form of toxoplasmosis, the case was diagnosed as acquired immune deficiency [AIDS]. The patient was sero - negative at presentation, but sero-conversion occurred five months later. The importance of antigen detection in cases of suspected immunodeficiency is emphasized