Neurorretinitis por Bartonella henselae en un adolescente / Bartonella henselae neuroretinitis in an adolescent

La neurorretinitis como manifestación de la enfermedad por arañazo de gato se presenta en el 1-2 % de los pacientes con afecciones oculares porBartonella henselae. Las manifestaciones oculares suelen suceder a las sistémicas, aunque pueden aparecer en ausencia de estas. La presencia de exudado macular en forma de estrella es característico y sugestivo de dicha infección. Se presenta el caso de un paciente de 14 años de edad, previamente sano, con disminución de la agudeza visual de 15 días de evolución, que ingresó por sospecha de neuritis óptica izquierda con edema de papila. El seguimiento oftalmológico reveló la aparición de la lesión característica en "estrella macular" que permitió arribar al diagnóstico de infección por B. henselae, confirmándose luego con serología positiva

Neurorretinitis as a manifestation of cat scratch disease occurs in 1-2 % of patients with Bartonella Henselae eye disease. Ocular manifestations tend to follow systemic ones, although they can appear in their absence. The presence of star-shaped macular exudate is characteristic and suggestive of this infection. We report a case of a 14-year-old healthy boy, with 15 days of decreased visual acuity, who was admitted for suspected left optic neuritis with papilledema. Ophthalmological examination revealed the characteristic "macular star" that led to the diagnosis of infection by Bartonella Henselae, later confirmed by positive serology.

¿Son las alteraciones en la mucosa oral un signo de COVID-19? Estudio transversal en un Hospital de Campaña / Are Oral Mucosal Changes a Sign of COVID-19? A Cross-Sectional Study at a Field Hospital

Introducción La enfermedad por coronavirus-19 (COVID-19) se ha relacionado con múltiples síntomas: respiratorios, trombóticos, neurológicos, digestivos o cutáneos. Estos últimos se han clasificado en 5 tipos: lesiones acroisquémicas, lesiones vesiculares, erupción urticarial, exantema maculopapular o lesiones livedoides. Sin embargo, se han descrito mucho menos las alteraciones orales asociadas a la COVID-19. Pacientes y métodos Presentamos un estudio transversal realizado durante abril del 2020 en el Hospital de Campaña de IFEMA examinando la mucosa oral de 666 pacientes con COVID-19. Resultados En total, 78 pacientes (11,7%) presentaron alteraciones en la mucosa oral. La más frecuente fue papilitis lingual transitoria anterior en forma de U (11,5%) asociada o no a edema lingual (6,6%); estomatitis aftosa (6,9%), mucositis (3,9%) glositis con depapilación en parches (3,9%), boca urente (5,3%), lengua saburral (1,6%) y enantema (0,5%). La mayoría refería disgeusia asociada. Conclusión La cavidad oral se puede alterar por la enfermedad COVID-19, el edema lingual con papilitis lingual transitoria en forma de U o la glositis con depapilación en parches son los signos encontrados con mayor frecuencia, al igual que la sensación de ardor en la cavidad oral o boca urente. Otras manifestaciones orales que se pueden asociar a la COVID-19 son mucositis con o sin aftas o el enantema. Todos pueden ser signos clave para un diagnóstico de esta enfermedad (AU)

Background Coronavirus disease 19 (COVID-19) has many manifestations, including respiratory, thrombotic, neurologic, digestive, and cutaneous ones. Cutaneous manifestations have been classified into 5 clinical patterns: acro-ischemic (pseudo-chilblain), vesicular, urticarial, maculopapular, and livedoid. Oral manifestations have also been reported, but much less frequently. Patients and methods We performed a cross-sectional study in which we examined the oral mucosa of 666 patients with COVID-19 at the IFEMA field hospital in Madrid in April 2020. Results Seventy-eight patients (11.7%) had changes involving the oral mucosa. The most common were transient anterior U-shaped lingual papillitis (11.5%) accompanied or not by tongue swelling (6.6%), aphthous stomatitis (6.9%), a burning sensation in the mouth (5.3%), mucositis (3.9%), glossitis with patchy depapillation (3.9%), white tongue (1.6%), and enanthema (0.5%). Most of the patients also reported taste disturbances. Conclusion COVID-19 also manifests in the oral cavity. The most common manifestations are transient U-shaped lingual papillitis, glossitis with patchy depapillation, and burning mouth syndrome. Mucositis with or without aphthous ulcers or enanthema may also be observed. Any these findings may be key clues to a diagnosis of COVID-19 (AU)

Are Oral Mucosal Changes a Sign of COVID-19? A Cross-Sectional Study at a Field Hospital. / ¿Son las alteraciones en la mucosa oral un signo de COVID-19? Estudio transversal en un Hospital de Campaña.

BACKGROUND: Coronavirus disease 19 (COVID-19) has many manifestations, including respiratory, thrombotic, neurologic, digestive, and cutaneous ones. Cutaneous manifestations have been classified into 5 clinical patterns: acro-ischemic (pseudo-chilblain), vesicular, urticarial, maculopapular, and livedoid. Oral manifestations have also been reported, but much less frequently. PATIENTS AND METHODS: We performed a cross-sectional study in which we examined the oral mucosa of 666 patients with COVID-19 at the IFEMA field hospital in Madrid in April 2020. RESULTS: Seventy-eight patients (11.7%) had changes involving the oral mucosa. The most common were transient anterior U-shaped lingual papillitis (11.5%) accompanied or not by tongue swelling (6.6%), aphthous stomatitis (6.9%), a burning sensation in the mouth (5.3%), mucositis (3.9%), glossitis with patchy depapillation (3.9%), white tongue (1.6%), and enanthema (0.5%). Most of the patients also reported taste disturbances. CONCLUSION: COVID-19 also manifests in the oral cavity. The most common manifestations are transient U-shaped lingual papillitis, glossitis with patchy depapillation, and burning mouth syndrome. Mucositis with or without aphthous ulcers or enanthema may also be observed. Any these findings may be key clues to a diagnosis of COVID-19.

Optical neuropathy due to inhaled cocaine, causality or chance. / Neuropatía óptica secundaria a consumo de cocaína inhalada. Causalidad o casualidad.

A 44-year-old man, active cocaine consumer, who referred decrease in visual acuity in the right eye in 24 hours of evolution, being 0,05 in that eye and 1 in the left eye. The examination showed a relative afferent pupil defect and a swelling head of optic nerve. The systemic studies performed were normal, except the nuclear magnetic resonance of the brain that showed a thickening of the maxillary and frontal sinus mucosa, compatible with sinusitis. Hospital admission and the start of intravenous corticosteroid treatment were decided, with a favourable evolution, a visual acuity of 1.0 in both eyes and an anatomical improvement of the optic nerve head. Due to the medical history of the patient and the assessment of other plausible alternative diagnoses, we established the diagnosis of optical neuropathy due to inhaled cocaine abuse.

Neurorretinitis por Bartonella henselae. Reporte de caso y revisión de la literatura / Bartonella henselae neuroretinitis. A case report and literature review

Introducción: La Enfermedad por Arañazo de Gato (EAG) es una enfermedad zoonótica causada por Bartonella henselae, un bacilo gram negativopleomórfi co. Sus manifestaciones clínicas varían de acuerdo a la respuesta inmunológica instaurada por el huésped, pudiendo ser de tipo granulomatosa o angioproliferativa. El diagnóstico es clínico, sin embargo, se utiliza la serología e imágenes multimodales para la confi rmación diagnóstica y el seguimiento de la misma. Objetivo: Describir el caso de una paciente joven que presenta aftasorales recurrentes como única manifestación sistémica de EAG asociado a neurorretinitis unilateral, quien es manejada con antibiótico en combinación con corticoide sistémico. Diseño del estudio: Reporte de caso Resumen del caso: Paciente con antecedente de contacto directo con gatoscachorros y aft as orales recurrentes; presenta disminución de la agudeza visual en ojo izquierdo. Al examen oft almológico presenta papilitis, hemorragias intrarretinianas y presencia de cicatriz coriorretiniana en ojo contralateral. Ante los hallazgos descritos se indica manejo antibiótico por sospecha de infección por toxoplasmosis, sin embargo, presenta evolución tórpida. Se realizan estudios complementarios que evidencian desprendimiento seroso de retina con evolución a estrella macular, por lo que se modifi ca el esquema antibiótico a los 15 días, presentando mejoría de la sintomatología. Conclusión: La neurorretinitis secundaria a enfermedad por arañazo de gato es una entidad subdiagnosticada en nuestro medio, lo que hace importante indagar sobre antecedentes de contacto con felinos y los posibles diagnósticos diferenciales. Es esencial establecer esquemas de manejo antibiótico basados en la literatura ante la sospecha de la enfermedad para evitar sus posibles complicaciones.

Background: Cat Scratch Disease is a zoonotic disease caused by Bartonella henselae, a pleomorphic gram negative bacillus. Its clinical manifestations vary according to the immune response established by the host, it may be a granulomatous or angioproliferative type. Th e diagnosis is based on clinical fi ndings, however, serology and multimodal images are used for diagnosis confi rmation and monitoring. Objective: To describe the case of a young patient, who presents recurrent oral thrush as the only systemic manifestation of CSD associated with unilateral neuroretinitis, who is managed with antibiotic in combination with systemic corticosteroid. Study Design: Case report. Case summary: Patient with a history of direct contact with puppy cats and recurrent oral thrush; presents decreased visual acuity in the left eye. During ophthalmological examination, she presents papillitis, intraretinal hemorrhages and the presence of a chorioretinal scar in the contralateral eye. Given the fi ndings described, antibiotic management is indicated due to suspected toxoplasmosis infection, however, she presents a torpid evolution. Th e complementary tests show serous retinal detachment with evolution to macular star, thus treatment regimen is modifi ed aft er 15 days with secondary symptoms improvement. Conclusion: Neuroretinitis secondary to cat scratch disease is an underdiagnosed entity in our setting, which makes it important to inquire about feline contact history and possible diff erential diagnoses. It is essential to establish antibiotic management schemes based on the literature when the disease is suspected to avoid its possible complications

Leber's idiopathic stellate neuroretinitis: diagnostic and therapeutic conflicts. / Neurorretinitis estrellada idiopática de Leber: conflictos diagnósticos y terapéuticos.

Three cases of patients with decreased visual acuity and papillitis at onset with subsequent macular star development after a few weeks are presented. Complementary tests were unremarkable in all included patients. Based on this clinical context, they were diagnosed with Leber's idiopathic stellate neuroretinitis, were treated with corticosteroids, as well as with antibiotics in 2cases. All patients showed favourable outcomes, although signs of papillary atrophy were observed in the affected eyes. Leber's idiopathic stellate neuroretinitis diagnosis can be challenging due to the wide spectrum of conditions that have to be ruled out. In addition, macular star may appear later on, which should not exclude its diagnosis. Use of antibiotics and/or corticosteroids is controversial considering its benign nature, but should be considered in selected severe cases. Moreover, the routine use of complementary tests should be carefully evaluated, mainly those that can be aggressive and/or expensive, which should be rationally used.

Papillitis and neuroretinitis of tuberculous etiology. / Papilitis y neurorretinitis de etiología tuberculosa.

A 57-year-old man with miliary tuberculosis reported visual loss in his right eye, a month after starting a four-drug antituberculous treatment regimen. On exploration, an inferior segmental optic disc edema was objectived and it was attributed to ischemic aetiology. Ethambutol was withdrawn and 60mg of oral prednisone daily were given with a tapering dosage. One and a half months later, he presented a sudden loss of vision in his left eye. In fundoscopy, a papillary edema accompanied by a foveal neurosensory detachment was observed but with no more accompanying uveitic signs. Treatment was intensified with moxifloxacin and corticosteroids were reduced, showing a resolution of the macular detachment but with optic atrophy. Isolated tuberculous involvement of the optic nerve may possible in the context of miliary tuberculosis. In this case, the adopted therapeutic approach to the initial papillitis, which was interpreted as ischemic, could favour the appearance of a neuroretinitis in the fellow eye.

Leukaemic infiltration and cytomegalovirus retinitis in a patient with acute T-cell lymphoblastic leukaemia in complete remission. / Infiltración leucémica y retinitis por citomegalovirus en paciente con leucemia linfoblástica aguda tipo T en remisión completa.

CLINICAL CASE: A 43-year-old woman in remission from T- cell acute lymphoblastic leukaemia was referred to our hospital with suspected leukaemic retinitis. The funduscopic examination of her left eye revealed multifocal yellow-white peripheral retinitis and retinal haemorrhage. The patient was treated for cytomegalovirus retinitis after an extended haematological investigation showed no abnormalities. Initial improvement was followed by papillitis in the left eye and motility restriction in the right eye. Magnetic resonance and lumbar puncture confirmed leukaemia relapse. Specific treatment was initiated with complete resolution. DISCUSSION: Ocular involvement may precede haematological leukaemia relapse. Physicians should be alerted when ocular symptoms appear in these cases.

Toxoplasmosis ocular. Descripción de tres pacientes con presentación atípica / Ocular toxoplasmosis. Description of three patients with an atypical presentation.

Objetivo: Describir una forma de presentación atípica de toxoplasmosis ocular, enfatizando la importancia de la jerarquización de los hallazgos clínicos y las limitaciones de la serología para realizar un diagnóstico temprano. Pacientes y Métodos: Estudio retrospectivo y descriptivo de tres casos clínicos de toxoplasmosis ocular activa, con presentación atípica (compromiso del nervio óptico), derivados al Servicio de Oftalmología del Hospital J. P. Garrahan en el periodo comprendido entre 2007 y 2010. Resultados: En los tres casos presentados la sospecha clínica de toxoplasmosis ocular no se correlacionó con evidencia serológica de infección reciente. En un caso, la terapéutica específica temprana, basada en la sospecha clínica, resultó en una excelente recuperación funcional. Un tratamiento tardío puede interferir en el resultado visual. Conclusiones: Basados en los hallazgos clínicos y la alta sospecha de esta patología debe iniciarse el tratamiento específico sin esperar que los resultados serológicos la confirmen. Eventualmente, la mejoría clínica confirmara el diagnóstico. El comportamiento de los títulos de anticuerpos en el curso de la enfermedad ocular no siempre es confiable, y en muchos casos retrasa el comienzo de la terapéutica con la consiguiente mala rehabilitación visual de estos pacientes (AU)

Objective: To describe an atypical presentation of ocular toxoplasmosis, emphasizing the importance of clinical findings and the limitations of serology in the early diagnosis. Patients and Methods: A retrospective, descriptive study was conducted of three cases with active ocular toxoplasmosis with an atypical presentation (optic nerve involvement), referred to the Department of Ophthalmology of Hospital J. P. Garrahan between 2007 and 2010. Results: In the three cases presented here clinical suspicion of ocular toxoplasmosis did not correlate with serological evidence of a recent infection. In one case, early treatment, based on clinical suspicion, resulted in excellent functional recovery. Late management may compromise visual outcome. Conclusions: Based on clinical findings and suspicion of the pathology, specific treatment should be started without waiting for serological confirmation. Eventually, clinical improvement will confirm the diagnosis. The behavior of antibody titres in the course of the ocular disease is not always reliable and often delays treatment initiation with subsequent difficulties in the visual rehabilitation of these patients (AU)

Caracterización de pacientes con neuritis óptica anterior en el Centro Oftalmológico de Santiago de Cuba / Characterization of patients with anterior optic neuritis in the ophthalmological center from Santiago de Cuba

Introducción: la neuritis óptica ha sido definida como el cuadro clínico resultante de la inflamación del nervio óptico en cualquier punto de su anatomía. Cuando la inflamación corresponde al disco óptico, se llama neuritis óptica anterior o papilitis. Objetivo: caracterizar los pacientes con neuritis óptica anterior. Métodos: se realizó un estudio descriptivo y transversal de los 48 pacientes con neuritis óptica anterior, atendidos en el Centro Oftalmológico del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, del 1 de enero al 31 de diciembre del 2012. Resultados: se obtuvo un predominio de la enfermedad en el grupo etario de 21-30 años (66,6 %) y en el sexo femenino (70,8 %); en tanto, 58,0 % de la serie era de procedencia urbana y 66,6 % declaró no tener hábitos tóxicos. Igualmente, se observó que en 45,8 % la entidad era de causa infecciosa y que la mayoría de los pacientes presentaba afectación monocular (95,8 %). Conclusiones: en la provincia de Santiago de Cuba, la neuritis óptica anterior se manifestó con mayor frecuencia en mujeres y personas jóvenes, con primacía del origen infeccioso. Los hábitos tóxicos no parecieron estar relacionados con la aparición de la oftalmopatía.

Introduction: the optic neuritis has been defined as the clinical resultant pattern of the optic nerve swelling at any point of its anatomy. When the inflammation corresponds to the optic disk, it is called optic neuritis or papillitis. Objective: to characterize the patients with anterior optic neuritis. Methods: a descriptive and cross-sectional study of the 48 patients with anterior optic neuritis, assisted in the Ophthalmological Center of "Dr. Juan Bruno Zayas Alfonso" General Hospital in Santiago de Cuba was carried out from January 1st to December 31st, 2012. Results: a prevalence of the disease was obtained in the age group 21-30 years (66.6%) and in the female sex (70.8%); as long as, 58.0% of the series had an urban origin and 66.6% declared not to have toxic habits. Equally, it was observed that in 45.8% the disease had an infectious cause and that most of the patients presented monocular damage (95.8%). Conclusions: the anterior optic neuritis showed a higher frequency in women and young people in Santiago de Cuba province, with primacy of the infectious origin. Toxic habits seem not to be related to the emergence of the ophthalmopathy.

Caracterización de pacientes con neuritis óptica anterior en el Centro Oftalmológico de Santiago de Cuba / Characterization of patients with anterior optic neuritis in the ophthalmological center from Santiago de Cuba

Introducción: la neuritis óptica ha sido definida como el cuadro clínico resultante de la inflamación del nervio óptico en cualquier punto de su anatomía. Cuando la inflamación corresponde al disco óptico, se llama neuritis óptica anterior o papilitis.Introducción: la neuritis óptica ha sido definida como el cuadro clínico resultante de la inflamación del nervio óptico en cualquier punto de su anatomía. Cuando la inflamación corresponde al disco óptico, se llama neuritis óptica anterior o papilitis. Objetivo: caracterizar los pacientes con neuritis óptica anterior. Métodos: se realizó un estudio descriptivo y transversal de los 48 pacientes con neuritis óptica anterior, atendidos en el Centro Oftalmológico del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, del 1 de enero al 31 de diciembre del 2012.Resultados: se obtuvo un predominio de la enfermedad en el grupo etario de 21-30 años (66,6 por ciento) y en el sexo femenino (70,8 por ciento); en tanto, 58,0 por ciento de la serie era de procedencia urbana y 66,6 por ciento declaró no tener hábitos tóxicos. Igualmente, se observó que en 45,8 por ciento la entidad era de causa infecciosa y que la mayoría de los pacientes presentaba afectación monocular (95,8 por ciento). Conclusiones: en la provincia de Santiago de Cuba, la neuritis óptica anterior se manifestó con mayor frecuencia en mujeres y personas jóvenes, con primacía del origen infeccioso. Los hábitos tóxicos no parecieron estar relacionados con la aparición de la oftalmopatía(AU)

Introduction: the optic neuritis has been defined as the clinical resultant pattern of the optic nerve swelling at any point of its anatomy. When the inflammation corresponds to the optic disk, it is called optic neuritis or papillitis. Objective: to characterize the patients with anterior optic neuritis. Methods: a descriptive and cross-sectional study of the 48 patients with anterior optic neuritis, assisted in the Ophthalmological Center of Dr Juan Bruno Zayas Alfonso General Hospital in Santiago de Cuba was carried out from January 1st to December 31st, 2012. Results: a prevalence of the disease was obtained in the age group 21-30 years (66.6 percent) and in the female sex (70.8 percent); as long as, 58.0 percent of the series had an urban origin and 66.6 percent declared not to have toxic habits. Equally, it was observed that in 45.8 percent the disease had an infectious cause and that most of the patients presented monocular damage (95.8 percent). Conclusions: the anterior optic neuritis showed a higher frequency in women and young people in Santiago de Cuba province, with primacy of the infectious origin. Toxic habits seem not to be related to the emergence of the ophthalmopathy(AU)

[Papillitis due to Epstein-Barr virus infection in an adult patient]. / Papilitis por infección del virus de Epstein-Barr en paciente adulto.

CASE REPORT: A 70-year- old woman who consulted due to poor vision in her right eye for 2 weeks. The examination showed a visual acuity (VA) of 0.6 and 1.0, with normal anterior pole and intraocular pressure and a relative afferent pupillary defect. Some papillitis was observed in the fundus of her right eye. The high levels of acute phase reactants led to an initial diagnosis of arteritic anterior ischemic optic neuropathy (AAION) and treatment with corticosteroids was started. DISCUSSION: According to the age of the patient, the fundus and the high levels of acute phase reactants, the initial diagnosis was AAION. However, the atypical papillitis features, with good AV and non-specific perimetry, together with a suitable medical history, and a profile of viral characteristics, with laboratory confirmation, led to the diagnosis of a primary papillitis infection due to Epstein-Barr virus, a very rare case due to the advanced age of the patient.

Neuritis óptica por picadura de abeja / Optic neuritis after a bee sting

La neuritis óptica es la inflamación aguda del nervio óptico y su forma atípica se produce por la inflamación del nervio óptico como parte de un proceso de causa infecciosa, inmune, granulomatosa, o por contigüidad. Las picaduras por himenópteros (abejas, avispas, hormigas) han sido asociadas con diferentes cuadros clínicos, que van desde manifestaciones locales hasta cuadros sistémicos como anafilaxis, glomerulonefritis y afectación del sistema nervioso central (lesiones vasculares e isquémicas, neuritis óptica y lesiones desmielinizantes). Desde 1960 se han documentado casos de neuritis ópticas asociadas a las picaduras de himenópteros, que adoptan las formas de neuritis óptica anterior isquémica e inflamatoria. Se presenta el caso de una paciente, mujer de 62 años de edad, que luego de tres días de haber sufrido picadura por abeja en párpado inferior izquierdo, presentó disminución de la agudeza visual de ambos ojos y escotoma central, concomitante con cefalea y dolor ocular bilateral exacerbado con los movimientos oculares. Al examen oftalmológico la agudeza visual se encontraba disminuida (visión en bultos). En el fondo de ojo se evidenció de forma bilateral discos ópticos de bordes borrados. En la resonancia magnética ocular se observó engrosamiento hiperintenso del nervio óptico izquierdo. Por las características clínicas y el antecedente epidemiológico se planteó el diagnóstico de neuritis óptica bilateral. Se inició pulsos de metilprednisolona, con posterior mejoría de la clínica.

Optic neuritis is an acute inflammation of the optic nerve and, in its atypical form, is caused by inflammation of the optic nerve as part of infectious, immune, granulomatous, or contiguity processes. Hymenoptera stings (bees, wasps and ants) have been associated with different clinical presentations, ranging from local events to systemic manifestations, such as anaphylaxis, glomerulonephritis and central nervous system involvement (ischemic vascular lesions, optic neuritis and demyelinating lesions). This is a report of the case of a 62-year-old woman that after three days of being stung by a bee in the left lower eyelid, showed decreased visual acuity of both eyes and central scotoma, concomitant bilateral headache and eye pain, exacerbated by eye movements. The ophthalmological examination showed that visual acuity was decreased and the bilateral fundus examination revealed blurred optic disks edges. Hyperintense thickening of the left optic nerve was observed with an ocular MRI. Due to the clinical manifestations and epidemiological history, the diagnosis of bilateral optic neuritis was established. Treatment with pulses of 1g/daily of methylprednisolone was initiated, for three days, with clinical improvement within 24 hours after receiving the first dose. Since 1960, cases of optic neuritis associated with hymenoptera stings have been documented, which take the form of anterior optic neuritis. A case of a patient who presented clinical features of bilateral optic neuritis after been stung by a bee, with a good clinical outcome after treatment with methylprednisolone is reported.

CMV Papillitis in Renal Transplant Recipient

Cytomegalovirus(CMV) ocular infection is one of the common ocular complications seen in immunocompromised condition, such as AIDS or organ transplant recipient receiving immunosuppressive drugs, CMV papillitis is known to be care. CMV papillitis has, however, a poor visual prognosis because the treatment is more resistant to than that of CMV retinitis. We report a case of CMV papillitis after the renal transplantation which has good result with long-term ganciclovir administration.