ABSTRACT
We report a case of atypical Cogan's syndrome presenting as bilateral endogenous endophthalmitis in a woman with ovarian cancer. A 62-year-old woman with ovarian cancer developed bilateral interstitial keratitis and panuveitis accompanied by bilateral sensorineural hearing loss and chondritis. Auricular cartilage biopsy ruled out relapsing polychondritis and the diagnosis of atypical Cogan's syndrome was set clinically.
Subject(s)
Cogan Syndrome/diagnosis , Endophthalmitis/diagnosis , Keratitis/diagnosis , Ovarian Neoplasms/complications , Polychondritis, Relapsing/diagnosis , Cogan Syndrome/complications , Cogan Syndrome/pathology , Diagnosis, Differential , Endophthalmitis/complications , Endophthalmitis/pathology , Female , Hearing Loss, Sensorineural/complications , Humans , Keratitis/complications , Keratitis/pathology , Middle Aged , Polychondritis, Relapsing/complications , Polychondritis, Relapsing/pathologyABSTRACT
We present the case of a 14-year-old girl who was admitted to the hospital with the complaint of horizontal diplopia for 48 hours. Initially, she was diagnosed with idiopathic intracranial hypertension. During hospitalization she developed fever, macular facial rash, and chest pain, and because of abnormal laboratory findings the diagnosis of systemic lupus erythematosus was established. She received immunomodulatory therapy, a combination of corticosteroids, and intravenous infusions of the monoclonal antibody rituximab, which augmented her clinical improvement. Intracranial hypertension secondary to systemic lupus erythematosus is a rare manifestation, especially as a presenting symptom. In addition, the fact that the patient developed an aggressive form of systemic lupus erythematosus during the initial period of hospitalization for idiopathic intracranial hypertension is also uncommon. Moreover, to our knowledge, we are not aware of any published case reports of intracranial hypertension secondary to systemic lupus erythematosus that was treated with rituximab.
Subject(s)
Diplopia/etiology , Lupus Erythematosus, Systemic/complications , Adolescent , Diplopia/diagnosis , Female , Fever/etiology , Humans , Optic Disk/diagnostic imaging , Optic Disk/pathology , Optic Nerve Diseases/etiology , RadiographyABSTRACT
PURPOSE: To evaluate contrast sensitivity in children and adolescents with diabetes mellitus without evidence of diabetic retinopathy. METHODS: Sixty patients with insulin-dependent diabetes mellitus (age range: 8 to 18 years) were studied. Their contrast sensitivity scores were obtained using the CSV-1000 device (Vector Vision, Dayton, OH) for four spatial frequencies and were compared with v scores of 45 age-matched and gender-matched "healthy" patients. Contrast sensitivity values were also correlated to patient's age, duration of disease, and metabolic control of diabetes mellitus. RESULTS: The patients with insulin-dependent diabetes mellitus had a significant contrast sensitivity score reduction at all spatial frequencies tested. Glycosylated hemoglobin levels were inversely related to the contrast sensitivity thresholds. No significant correlation was found between the contrast sensitivity scores and the patient's age or duration of disease. CONCLUSION: Contrast sensitivity defects are detected in patients with insulin-dependent diabetes mellitus. These defects may represent an early dysfunction of the retina, visual pathway, or both in patients with insulin-dependent diabetes mellitus who do not show any signs of diabetic retinopathy.
Subject(s)
Contrast Sensitivity/physiology , Diabetes Mellitus, Type 1/physiopathology , Vision Disorders/physiopathology , Adolescent , Blood Glucose/metabolism , Child , Female , Glycated Hemoglobin/metabolism , Humans , Male , Vision Tests/instrumentation , Vision Tests/methods , Visual Acuity/physiologyABSTRACT
PURPOSE: To present an atypical case of acanthamoeba keratitis in a soft contact lens wearer. METHODS: A case report of a 28-year-old female soft contact lens wearer with a 6-day history of redness and blurred vision in her right eye. Examination showed stromal keratitis that did not respond to therapy for herpes simplex virus. Four weeks later, the patient had increased stromal infiltration, an endothelial plaque, and a hypopyon. She did not complain of pain apart from mild discomfort. Corneal smears and anterior chamber tap were negative for bacteria, fungi, acanthamoeba, and herpes simplex virus, and the patient was prescribed fortified antibiotics. One week later, a large epithelial defect with a surrounding ring infiltrate was apparent. Corneal biopsy showed acanthamoeba. RESULTS: The acanthamoeba keratitis resolved with successful treatment. One year later, the patient had a residual visual deficit secondary to stromal scarring and her best-corrected visual acuity was 20/29. CONCLUSIONS: This case emphasizes the importance of considering acanthamoeba species in the differential diagnosis of keratitis, even without the classic symptom of severe pain. A high degree of suspicion with rapid and appropriate treatment may result in improved recovery of vision.
