ABSTRACT
PURPOSE: The study reports an unusual presentation of a young female patient presenting with a granulomatous posterior pole mass and profound vision loss secondary to infection with Bartonella henselae. METHODS: A single case report in a child. RESULTS: An 8-year-old female presented with a recent history of flu-like illness associated with profound vision loss, panuveitis and leukocoria in the left eye. She was found to have a posterior granulomatous mass associated with an exudative retinal detachment presumed as a toxocara granuloma. Magnetic Resonance Imaging ruled out retinoblastoma. Lab work done was negative for toxocariasis and positive for Bartonella henselae titers. She was treated for Cat Scratch Disease (CSD) with steroids and azithromycin. With treatment, the inflammation and exudative retinal detachment resolved, however, the patient had no improvement in visual acuity. CONCLUSIONS: Young patients presenting with leukocoria need a full work up, which includes ruling out retinoblastoma. CSD can present as a granulomatous mass similar to toxocariasis, which can rarely lead to debilitating and irreversible vision loss.
Subject(s)
Cat-Scratch Disease/complications , Eye Infections, Bacterial/complications , Granuloma/etiology , Optic Disk/pathology , Optic Nerve Diseases/etiology , Visual Acuity , Bartonella henselae/isolation & purification , Cat-Scratch Disease/diagnosis , Child , Diagnosis, Differential , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/microbiology , Female , Fluorescein Angiography , Fundus Oculi , Granuloma/diagnosis , Granuloma/microbiology , Humans , Optic Disk/microbiology , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/microbiology , UltrasonographyABSTRACT
Neurofibromatosis type 1 (NF-1) is an autosomal dominant familial tumor predisposition syndrome characterized by the growth of benign and malignant tumors involving the peripheral and central nervous system. In the following report, the authors describe a case of a 1-year-old child with NF-1, who underwent enucleation for a blind, proptotic, painful eye with subsequent histopathological examination revealing choroidal ganglioneuroma, a very rare entity.
Subject(s)
Choroid Neoplasms/diagnosis , Choroid/diagnostic imaging , Ganglioneuroma/diagnosis , Neurofibroma, Plexiform/diagnosis , Neurofibromatosis 1/complications , Biopsy , Choroid Neoplasms/complications , Diagnosis, Differential , Female , Ganglioneuroma/complications , Humans , Infant, Newborn , Neurofibroma, Plexiform/complications , Neurofibromatosis 1/diagnosis , Tomography, X-Ray ComputedABSTRACT
Diagnosing Horner Syndrome can be difficult in the setting of an incomplete triad. A 27-year-old man presented with unilateral eyelid droop and intermittent ipsilateral headaches, having already seen 7 physicians. Physical examination revealed unilateral ptosis but no pupillary miosis or facial anhidrosis. Inspection of his clinical photographs revealed elevation of the ipsilateral lower eyelid, suggesting sympathetic dysfunction. On further questioning, he admitted to naphazoline dependence. Reexamination after ceasing the naphazoline unveiled the anisocoria. Vascular imaging subsequently revealed carotid dissection, and the patient was started on anticoagulant and antiplatelet therapy. The ptosis persisted after conjunctival Müllerectomy. External levator resection was recommended, but patient declined. This case underscores the importance of clinical photography, meticulous medical record review, and complete medication history including over-the-counter preparations. Clinicians should meticulously inspect the lower eyelid in cases of atypical blepharoptosis and consider the effects of eye drops when inspecting pupils for miosis.
