Fever and an abnormal chest X-ray during the COVID-19 pandemic.

During the COVID-19 pandemic, a 56-year-old man presented at our emergency department with fever and shortness of breath; Diffuse pulmonary nodular vascular spread lesions were found. Detailed history taking showed a four-week history of fever and night sweats. The man had been under treatment for 2 years with Adalimumab, a tumor-necrosis-factor (TNF) inhibitor, for ulcerative colitis. Before start, screening by tuberculin skin test was negative. Cultures en PCR on BAL and urine were positive for mycobacterium tuberculosis also ocular findings were present. The diagnosis of military tuberculosis was made.

Bilateral diffuse uveal melanocytic proliferation with good clinical response to plasmapheresis and treatment of the primary tumor.

PURPOSE: To report successful treatment of bilateral diffuse uveal melanocytic proliferation. METHODS: Case report of a patient with clinical diagnosis of bilateral diffuse uveal melanocytic proliferation, imaged with fluorescein angiography and spectral domain optical coherence tomography, and with follow-up data after treatment with plasmapheresis, radiation, and chemotherapy. RESULTS: A 67-year-old white man presented with a history of bilateral rapidly declining vision. The ophthalmoscopic examination, fluorescein angiography, and optical coherence tomography showed in both eyes an exudative retinal detachment and subretinal lesions highly suggestive for bilateral diffuse uveal melanocytic proliferation. Further investigation demonstrated a large cell lung carcinoma. Subsequently, the patient was treated with plasmapheresis, radiation, and chemotherapy. In a few weeks, the exudative retinal detachments resolved with gain of vision, and the retina remained flat during the 5-month follow-up. CONCLUSION: Plasmapheresis and treatment of the primary tumor are valuable treatment options for visually impaired patients with bilateral diffuse uveal melanocytic proliferation.

Macular telangiectasia type 2 (MacTel) in a 34-year-old patient.

We report macular telangiectasia type 2 (MacTel) in a 34-year-old man, the youngest patient so far published with MacTel type 2. The patient presented with metamorphopsia and impaired reading ability. Diagnosis was based on bilateral abnormal macular autofluorescence, perifoveal telangiectasia with fluorescein angiographic hyperfluorescence without cystoid oedema, a small foveal avascular zone, asymmetric configuration of the foveal pit, disruptions in the inner segment/outer segment layer and hyper-reflective haze and spots in the outer nuclear layer. Although MacTel usually manifests with a slowly progressive decrease in visual acuity in the fifth to seventh decades of life, younger patients may occasionally be diagnosed with the disease. Awareness of subtle signs of the condition is essential for early diagnosis.

Photodynamic therapy for subfoveal classic choroidal neovascularization related to punctate inner choroidopathy (PIC) or presumed ocular histoplasmosis-like syndrome (POHS-like).

PURPOSE: To evaluate the safety and efficacy of photodynamic therapy with verteporfin (PDT) for subfoveal classic choroidal neovascularization (CNV) related to punctate inner choroidopathy (PIC) or presumed ocular histoplasmosis-like syndrome (POHS-like). METHODS: Retrospective review of 16 eyes from 14 patients with subfoveal classic CNV associated with PIC or POHS-like and treated with PDT. RESULTS: The mean visual acuity increased from 4.5/10 (range: 1/10-9/10) to 7/10 (range: 2/10-10/10) after a mean follow-up of 21 months (range: 8-32 months) and a mean number of 2 PDT (range: 1-6). Visual acuity remained stable or improved in 13 of the 16 eyes (81%) and decreased in three. CONCLUSION: This nearly two-year follow-up study suggests that PDT could be helpful for patients with subfoveal classic CNV related to PIC or POHS-like.