ABSTRACT
BACKGROUND: Bilateral acute uveitis can cause significant morbidity, and a complete workup is often warranted. This report illustrates a case of sarcoid uveitis definitively diagnosed by skin biopsy in a patient with red tattoo ink. CASE REPORT: A 40-year-old African American male presented with bilateral photophobia and intraocular pressures of 26 mmHg in both eyes, 1+ grade cell and flare in both eyes, and granulomatous (mutton fat) keratic precipitates in both eyes. Serum angiotensin-converting enzyme level was elevated at 146 U/mL (normal value <40 U/mL), and computed tomography imaging revealed mediastinal and hilar lymphadenopathy. Multifocal induration and elevation in the areas of red pigment of a tattoo were also present and on punch biopsy revealed noncaseating granulomas, confirming the diagnosis of sarcoid uveitis. CONCLUSION: Our case suggests that a complete physical examination and inquiry about the presence of any tattoos should be conducted as part of the workup of uveitis.
ABSTRACT
BACKGROUND: Nonarteritic anterior ischemic optic neuropathy (NAAION) has a poorly understood etiology, and the onset of simultaneous bilateral NAAION in a patient <50 years without identifiable systemic risk factors is rare. CASE REPORT: We present the case of a patient with acute painless monocular vision loss and bilateral optic disc edema who subsequently developed painless vision loss in the fellow eye. The patient's history was significant for diffuse large B-cell lymphoma, and our pressing diagnostic concern was to determine if his vision loss and bilateral optic disc changes represented lymphomatous infiltrates. A complete ocular exam demonstrated findings consistent with simultaneous bilateral NAAION. After an extensive systemic workup for malignancy with central nervous system involvement, vasculitis, and other entities associated with NAAION, we determined that the patient's primary risk factor for developing bilateral ischemic optic neuropathies was his crowded optic discs. CONCLUSION: This case supports the hypothesis that a crowded optic disc is a sufficient primary risk factor for developing NAAION.
ABSTRACT
PURPOSE: To report a case of gross hematuria in a patient with previously undiagnosed urothelial carcinoma of the right ureter after intravitreal bevacizumab (Avastin) injections. METHODS: In this case report and review of the literature, an 81-year-old woman presented with neovascular age-related macular degeneration in the left eye. She was treated with repeated intravitreal bevacizumab (Avastin) injections. After injection, she reported two episodes of gross hematuria. After disclosing this information to her ophthalmologist, bevacizumab treatment was suspended and the hematuria resolved. Urological evaluation revealed no abnormalities. Approximately 1 year later, treatment with intravitreal bevacizumab was resumed. After three injections, she again reported gross hematuria. Urological evaluation at that time revealed a high-grade urothelial carcinoma of the right ureter. A right nephroureterectomy was performed, and bevacizumab treatment was resumed. She did not report any subsequent episodes of hematuria. CONCLUSION: Hematuria has previously been reported with systemic administration of bevacizumab. However, hematuria after intravitreal injections of bevacizumab has not been reported and is most likely occurring as a result of the systemic absorption of the drug. Further investigation of the systemic effects of intravitreal bevacizumab may be warranted.
Subject(s)
Angiogenesis Inhibitors/adverse effects , Antibodies, Monoclonal, Humanized/adverse effects , Carcinoma, Transitional Cell/complications , Hematuria/chemically induced , Ureteral Neoplasms/complications , Aged, 80 and over , Bevacizumab , Female , Humans , Intravitreal Injections , Macular Degeneration/drug therapy , RecurrenceABSTRACT
The aim of this study is to investigate the ability of intramuscular and intravenous sulfanegen sodium treatment to reverse cyanide effects in a rabbit model as a potential treatment for mass casualty resulting from cyanide exposure. Cyanide poisoning is a serious chemical threat from accidental or intentional exposures. Current cyanide exposure treatments, including direct binding agents, methemoglobin donors, and sulfur donors, have several limitations. Non-rhodanese mediated sulfur transferase pathways, including 3-mercaptopyruvate sulfurtransferase (3-MPST) catalyze the transfer of sulfur from 3-MP to cyanide, forming pyruvate and less toxic thiocyanate. We developed a water-soluble 3-MP prodrug, 3-mercaptopyruvatedithiane (sulfanegen sodium), with the potential to provide a continuous supply of substrate for CN detoxification. In addition to developing a mass casualty cyanide reversal agent, methods are needed to rapidly and reliably diagnose and monitor cyanide poisoning and reversal. We use non-invasive technology, diffuse optical spectroscopy (DOS) and continuous wave near infrared spectroscopy (CWNIRS) to monitor physiologic changes associated with cyanide exposure and reversal. A total of 35 animals were studied. Sulfanegen sodium was shown to reverse the effects of cyanide exposure on oxyhemoglobin and deoxyhemoglobin rapidly, significantly faster than control animals when administered by intravenous or intramuscular routes. RBC cyanide levels also returned to normal faster following both intramuscular and intravenous sulfanegen sodium treatment than controls. These studies demonstrate the clinical potential for the novel approach of supplying substrate for non-rhodanese mediated sulfur transferase pathways for cyanide detoxification. DOS and CWNIRS demonstrated their usefulness in optimizing the dose of sulfanegen sodium treatment.
