ABSTRACT
We report a clinical case of orbital lymphoma masquerading as orbital cellulitis. Orbital lymphoma and lymphoma of the orbital adnexa are relatively rare types of lymphoma. They represent the malignant end of a spectrum of lymphoproliferative lesions that occur in the orbit, conjunctiva and eyelid. Diffuse large B-cell lymphomas (DLBCL) with variable clinical presentations have a relatively poor prognosis with rapid visual loss. Therefore, thorough evaluation and assessment with a multi-specialty effort are warranted for earlier diagnosis and initiation of treatment to save life and prevent sight loss.
Subject(s)
Lymphoma, Large B-Cell, Diffuse , Orbital Cellulitis , Orbital Neoplasms , Humans , Lymphoma, Large B-Cell, Diffuse/diagnosis , Lymphoma, Large B-Cell, Diffuse/drug therapy , Lymphoma, Large B-Cell, Diffuse/pathology , Orbit , Orbital Cellulitis/diagnosis , Orbital Neoplasms/diagnosis , Orbital Neoplasms/pathology , Orbital Neoplasms/therapyABSTRACT
OBJECTIVE: To compare the metabolite concentration of optic radiation in glaucoma patients with that of healthy subjects using Proton Magnetic Resonance Spectroscopy (1H-MRS). METHODS: 1H-MRS utilising the Single-Voxel Spectroscopy (SVS) technique was performed using a 3.0Tesla MRI on 45 optic radiations (15 from healthy subjects, 15 from mild glaucoma patients, and 15 from severe glaucoma patients). A standardised Volume of Interest (VOI) of 20 × 20 × 20 mm was placed in the region of optic radiation. Mild and severe glaucoma patients were categorised based on the Hodapp-Parrish-Anderson (HPA) classification. Mean and multiple group comparisons for metabolite concentration and metabolite concentration ratio between glaucoma grades and healthy subjects were obtained using one-way ANOVA. RESULTS: The metabolite concentration and metabolite concentration ratio between the optic radiations of glaucoma patients and healthy subjects did not demonstrate any significant difference (p > 0.05). CONCLUSION: Our findings show no significant alteration of metabolite concentration associated with neurodegeneration that could be measured by single-voxel 1H-MRS in optic radiation among glaucoma patients. KEY POINTS: ⢠Glaucoma disease has a neurodegenerative component. ⢠Metabolite changes have been observed in the neurodegenerative process in the brain. ⢠Using SVS, no metabolite changes in optic radiation were attributed to glaucoma.
Subject(s)
Biomarkers/metabolism , Glaucoma, Open-Angle/pathology , Proton Magnetic Resonance Spectroscopy/methods , Adult , Aged , Analysis of Variance , Aspartic Acid/analogs & derivatives , Aspartic Acid/metabolism , Choline/metabolism , Creatine/metabolism , Cross-Sectional Studies , Female , Glutamic Acid/metabolism , Glutamine/metabolism , Humans , Magnetic Resonance Spectroscopy/methods , Male , Middle Aged , Nerve Fibers/metabolism , Nerve Fibers/pathology , Optic Nerve/metabolism , Radiation Dosage , Young AdultABSTRACT
A 23-year-old man presented with central retinal vein occlusion. The retinal haemorrhages worsened and signs of retinal vasculitis appeared later as vision dropped from 6/60 to Counting Fingers. No signs of systemic disease were observed. Routine Mantoux test and chest radiograph were negative for tuberculosis. Fundus flourescein angiogram confirmed presence of retinal vasculitis. Both systemic and topical corticosteroid therapy were ineffective. Polymerase chain reaction analysis of vitreous fluid showed presence of Mycobacterium tuberculosis. A full 6-month course of antituberculosis therapy was given and inflammation subsided. Vision improved to 3/60. This is a rare case of ocular tuberculosis without evidence of systemic infection, presenting first as a central retinal vein occlusion.
