ABSTRACT
Ethambutol and isoniazid are antimicrobial agents used to treat multi-drug-resistant tuberculosis. The most commonly recognized toxic effect of these drugs is optic neuropathy, usually manifesting as a decrease in visual acuity, deficits in colour vision and cecocentral scotomas. This study presents the case of a 59-year-old Nigerian woman diagnosed of multi-drug-resistant tuberculosis who developed a severe bilateral optic neuropathy induced by ethambutol and isoniazid. Ophthalmologic examination revealed normal intraocular pressure, normal funduscopic examination and normal biomicroscopy. Automated visual field revealed 360º peripheral constriction and central scotoma. Magnetic resonance images of the brain and orbits were normal. Ten months after suspending treatment, the patient recovered complete visual function. Visual loss is a rare complication that can be related to ethambutol and isoniazid toxicity. Both eyes are usually symmetrically affected with deficits in colour vision and cecocentral scotoma. For successful treatment of visual loss, it is important to make a differential diagnosis between infection and adverse effects of anti-TB drugs. Ophthalmological examination is thus important before and after treatment.
Subject(s)
Antitubercular Agents/adverse effects , Ethambutol/adverse effects , Isoniazid/adverse effects , Optic Nerve Diseases/chemically induced , Female , Humans , Middle Aged , Severity of Illness IndexABSTRACT
Choroidal melanoma is the most common primary intraocular cancer in adults. Metastases are most commonly found in the liver and are rapidly fatal despite aggressive therapy. These metastases have been reported in the follow-up to 50 % of uveal melanoma. However, recent reports have shown that liver ultrasonography and liver function tests have low sensitivity in the diagnosis of metastatic uveal melanoma. The study reports on a patient with a history of choroidal melanoma. Preoperative medical evaluation, including CT imaging of the abdomen, complete blood count and liver enzymes proved negative. A PET/CT was requested and showed lesions in the liver and lungs. Whole-body PET/CT revealed melanoma metastases. The PET/CT is a sensitive tool for the detection and localization of hepatic and extrahepatic metastatic choroidal melanoma.
Subject(s)
Choroid Neoplasms/diagnosis , Choroid Neoplasms/secondary , Melanoma/diagnosis , Melanoma/secondary , Multimodal Imaging/methods , Neoplasms, Unknown Primary , Positron-Emission Tomography/methods , Tomography, X-Ray Computed/methods , Aged , Humans , MaleABSTRACT
El etambutol e isoniacida son tuberculostáticos para la tuberculosis multirresistente cuyo efecto adverso es la neuropatía óptica, con pérdida de visión, alteración de percepción de los colores y escotomas cecocentrales. Se presenta el caso de una mujer nigeriana de 59 años con antecedentes de tuberculosis miliar que desarrolló neuropatía óptica bilateral severa secundaria aetambutol e isoniacida. La presión intraocular, fondo de ojo y polo anterior eran normales. La campimetría mostraba constricción periférica de 360º y escotoma central. La resonancia magnética craneal y orbitaria fue normal. Diez meses tras suspender el tratamiento recuperó la visión con mejoría del campo visual. La toxicidad de los antituberculosos se puede asociar en raras ocasiones a la pérdida de visión. Ambos ojos se suelen afectar de forma simétrica mostrando déficits en la percepción de colores y escotomas cecocentrales. Para establecer el tratamiento de esta pérdida de visión hay que hacer diagnóstico diferencial entre infección tuberculosa y efecto adverso de los fármacos. Por ello es fundamental la exploración oftalmológica antes y durante el tratamiento (AU)
Ethambutol and isoniazid are antimicrobial agents used to treat multi-drug-resistant tuberculosis. The most commonly recognized toxic effect of these drugs is optic neuropathy, usually manifesting as a decrease in visual acuity, deficits in colour vision and cecocentral scotomas. This study presents the case of a 59-year-old Nigerian woman diagnosed of multi-drug-resistant tuberculosis who developed a severe bilateral optic neuropathy induced by ethambutol and isoniazid. Ophthalmologic examination revealed normal intraocular pressure, normal funduscopic examination and normal biomicroscopy. Automated visual field revealed 360º peripheral constriction and central scotoma. Magnetic resonance images of the brain and orbits were normal. Ten months after suspending treatment, the patient recovered complete visual function. Visual loss is a rare complication that can be related to ethambutol and isoniazid toxicity. Both eyes are usually symmetrically affected with deficits in colour vision and cecocentral scotoma. For successful treatment of visual loss, it is important to make a differential diagnosis between infection and adverse effects of anti-TB drugs. Ophthalmological examination is thus important before and after treatment (AU)
Subject(s)
Humans , Female , Middle Aged , Optic Nerve Diseases/chemically induced , Optic Nerve Diseases/complications , Optic Nerve Diseases/diagnosis , Ethambutol/administration & dosage , Ethambutol/adverse effects , Isoniazid/administration & dosage , Isoniazid/adverse effects , Diagnosis, Differential , Optic Nerve Diseases/physiopathology , Optic Nerve Diseases/therapy , Vision Disorders/complications , Scotoma/complications , Intraocular Pressure , Constriction, PathologicABSTRACT
El melanoma coroideo es el tumor maligno ocular primario más frecuente en los adultos y las metástasis más frecuentes son a nivel hepático con un mal pronóstico a pesar de los tratamientos. Estas metástasis se han descrito hasta en el 50 % de los melanomas coroideos. Estudios recientes muestran que la ecografía hepática y las analíticas hepáticas tienen baja sensibilidad en el diagnóstico de las metástasis hepáticas de los melanomas de úvea. Exponemos el caso de un paciente con historia de melanoma coroideo. La exploración preoperatoria, incluyendo TC de abdomen, analítica sanguínea y enzimas hepáticos resultó normal. En un PET/TC realizado mostró lesiones en el hígado y pulmones. El PET/TC de cuerpo entero mostró metástasis de un melanoma uveal. El PET/TC es una herramienta útil para la detección de las metástasis hepáticas y extrahepáticas (AU)
Choroidal melanoma is the most common primary intraocular cancer in adults. Metastases are most commonly found in the liver and are rapidly fatal despite aggressive therapy. These metastases have been reported in the follow-up to 50 % of uveal melanoma. However, recent reports have shown that liver ultrasonography and liver function tests have low sensitivity in the diagnosis of metastatic uveal melanoma. The study reports on a patient with a history of choroidal melanoma. Preoperative medical evaluation, including CT imaging of the abdomen, complete blood count and liver enzymes proved negative. A PET/CT was requested and showed lesions in the liver and lungs. Whole-body PET/CT revealed melanoma metastases. The PET/CT is a sensitive tool for the detection and localization of hepatic and extrahepatic metastatic choroidal melanoma (AU)
Subject(s)
Humans , Male , Choroid Plexus Neoplasms/complications , Choroid Plexus Neoplasms/diagnosis , Eye Neoplasms/complications , Eye Neoplasms/diagnosis , Neoplasm Metastasis/pathology , Liver Neoplasms/complications , Liver Neoplasms/diagnosis , Prognosis , Melanoma/complications , Melanoma/pathology , Abdomen/pathology , Abdomen , Positron-Emission Tomography/instrumentation , Positron-Emission Tomography/methods , Positron-Emission Tomography/trendsSubject(s)
Sculpture/history , Tears , Water Supply/history , Byzantium , History, Ancient , MythologySubject(s)
Humans , History, 19th Century , Cacao/economics , Cacao/history , Sweden/ethnology , Registered Trademarks , Eye , Food Industry/historyABSTRACT
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