ABSTRACT
OBJECTIVES: To describe clinical presentation and results of diagnostic and therapeutic procedures in seven children from an epidemic of panuveitis in the Brazilian Amazonia, as well as environmental analysis and etiological aspects involved. METHODS: Patients underwent full pediatric and ophthalmic examinations, B-scan, ultrasound biomicroscopy, and serological tests. Ocular samples were thoroughly analyzed, including two enucleation specimens. Environmental investigation encompassed water, soil, and river fauna. RESULTS: All patients had bathed in the waters of a regional river, the Araguaia. Six of them presented with intermediate uveitis, with snowbanking. Five had cataract and four showed inferior endothelial opacity, with localized anterior synechiae. One showed total leukoma, with flat anterior chamber. Only two had active uveitis, one of them with anterior chamber nodule. Serology revealed high prevalence of anti-Toxocara canis immunoglobulin G (IgG) antibodies. In three cases, vitreous and lens samples disclosed spicules of freshwater sponges Drulia uruguayensis and D. ctenosclera, also detected in the waters of the river. CONCLUSION: Freshwater sponge spicules could be potential new etiological agents of ocular pathology, but further studies are needed, considering the heterogeneity of the ocular lesions and results of serological and environmental studies.
Subject(s)
Disease Outbreaks , Panuveitis/etiology , Panuveitis/physiopathology , Adolescent , Animals , Antibodies, Helminth/immunology , Brazil/epidemiology , Child , Female , Humans , Lens, Crystalline/parasitology , Male , Panuveitis/epidemiology , Panuveitis/pathology , Porifera , Rivers/parasitology , Toxocara canis/immunology , Vision, Low/diagnosis , Vision, Low/parasitology , Vitreous Body/parasitologyABSTRACT
Alertar para o fato de que os bisfosfonatos, importante classe de drogas utilizada no tratamento da osteoporose, podem causar esclerite. Relatamos caso de uma paciente que apresentou episódio de esclerite durante o uso de alendronato e que recidivou com o uso de outra droga da mesma classe, o risedronato, um ano depois. Os bisfosfonatos constituem uma classe de drogas que tem sido, frequentemente, utilizada no tratamento da osteoporose. No entanto, boa parte da classe médica pode não estar alerta para os efeitos colaterais oculares, tendo em vista que não se encontrou relato desses efeitos na literatura nacional. Este trabalho mostra dois episódios de esclerite, ocorridos em uma mesma paciente, com intervalo de, aproximadamente, um ano, possivelmente, provocados pelo uso de dois tipos de bisfosfonatos. Nas duas ocasiões, houve resposta favorável à suspensão da droga, com a utilização de um tratamento pouco agressivo. Esse fato justificou a não realização da pesquisa de doenças consideradas causas de esclerite, das quais a paciente não apresentava sinais, sintomas, assim como qualquer história pregressa. Tudo isso, associado à existência, na literatura internacional, de relatos de casos de inflamação ocular, inclusive de esclerite, relacionados com o uso dos bisfosfonatos, reforça a hipótese de que os episódios, realmente, tenham sido provocados pelo uso da droga.
To alert to the fact that bisphosphonates, important class of drugs used in the treatment of osteoporosis, can cause scleritis. Report of a female patient's case, who presented an episode of scleritis while using alendronate, and who had one year later another episode during the use of a drug from the same class, risedronate. The bisphosphonates are a class of drugs, which have been used very often in the treatment of osteoporosis. However, a great part of the physicians can not be alert for its ocular side effects, considering that in the national literature there's no report of these effects. This article report two episodes of scleritis, occurred to a patient, in a period of one year, probably caused by the use of two types of bisphosphonates. In these two opportunities, there was recovery after the suspension of the drug, associated with a less aggressive treatment. This fact justified not to perform the search for diseases considered to be the cause of scleritis, of which the patient didn't show any sign, symptom or past clinical history. These facts, associated to the existence of some reports of ocular inflammation, including scleritis, associated to the use of bisphosphonates, reinforces the hypothesis that the episodes, in fact, have been caused by the use of the drug.
