Bilateral anterior uveitis in a patient with bacterial meningitis.

We report a case of bilateral iridocyclitis accompanied by bacterial meningitis in an immunocompetent patient. Case report. A 48 year-old healthy female visited our hospital with strong headache, fever, bilateral hyperemia, and blurred vision in both eyes. A slit-lamp examination revealed moderate cells and flare in the anterior chamber of both eyes, with fine keratoprecipitates. There were no obvious inflammatory changes in the vitreous, retina, and optic disc of both eyes. Elevation of peripheral blood white blood cells, C-reactive protein, and an elevated number of cerebrospinal fluid (CSF) cells suggested bacterial meningitis. The patient was admitted to our hospital and received intravenous antibiotics. Finally, a CSF culture revealed infection with gram-positive rods, suspected Listeria monocytogenes, confirming bacterial meningitis. For iridocyclitis, we prescribed betamethasone eyedrops and 0.5 % tropicamide eyedrops with intravenous adminstration of systemic antibiotics. 3 days later, her headache and bilateral hyperemia disappeared. This case is better described as sterile reactive uveitis rather than endogenous bacterial endophthalmitis, because bilateral anterior uveitis was resolved without chronic uveitis, iris atrophy, and vitreous opacity. When clinicians see patients with meningitis and bilateral anterior uveitis, sterile reactive uveitis should be considered in the differential diagnosis of uveitis.

Association between Helicobacter pylori infection and Posner-Schlossman syndrome.

OBJECTIVE: To investigate possible association between Helicobacter pylori infection and Posner-Schlossman syndrome. METHODS: In a prospective study, 40 subjects with Posner-Schlossman syndrome were examined. As a control group, 73 subjects without Posner-Schlossman syndrome were selected for comparison with the study group. All participants underwent serologic analysis for the presence of H. pylori infection by an enzyme-linked immunosorbent assay. Positive rate of serum anti-H. pylori IgG was compared between Posner-Schlossman syndrome patients and control participants. RESULTS: The rate of positive titre (>15 U/ml) of H. pylori was 80.0% in the Posner-Schlossman syndrome group and 56.2% in control group, showing significant difference (Fischer's exact, P=0.014). Multivariate analysis adjusted for various systemic factors revealed that positive titre of anti-H. pylori IgG was a significant risk factor for Posner-Schlossman syndrome with an odds ratio, (4.84, 95.0% CI: 1.10-21.24, P=0.037). CONCLUSIONS: H. pylori infection occurred significantly more often in Posner-Schlossman syndrome patients. This study suggests that exposure to H. pylori infection is associated with Posner-Schlossman syndrome in Korea.

[Ocular leprosy: a historical approach]. / Hanseníase ocular: uma abordagem histórica.

A sharp drop in the prevalence of leprosy occurred in the last three decades. However, the incidence has not decreased at the same rate. Three years after the World Health Organization last deadline for leprosy control, patients considered healed still need special care for their incapacities and immunopathological reactions. Medical literature reffers blindness in 4% to 11% of studied patients and more than 20% with severe visual problems due to corneal exposure, bacillary invasion and hipersensibility. These mechanisms result in a population of nearly one million blind leprosy patients even though official prevalence accounts no more than 250,000 patients worldwide. The author calls for better patients management and follow-up and urges ophthalmologists to become more aware and interested in the treatment of the ocular complications of leprosy.

Hanseníase ocular: uma abordagem histórica / Ocular leprosy: a historical approach

Houve uma acentuada queda na prevalência da hanseníase nas últimas três décadas. Contudo, a incidência não diminuiu na mesma proporção. Hoje, três anos após a última data estipulada pela Organização Mundial da Saúde para o controle da hanseníase, pacientes considerados curados ainda necessitam de cuidados especiais por causa de suas incapacidades e reações imunológicas. A literatura médica refere cegueira em 4 por cento a 11 por cento dos pacientes estudados e, mais de 20 por cento com graves problemas visuais devido a exposição da córnea, invasão bacilar e hipersensibilidade; estes mecanismos resultam em uma população de aproximadamente 1 milhão de pacientes cegos, embora a prevalência oficial não passe de 250.000 pacientes em todo o mundo. O autor destaca a necessidade de melhor tratamento e acompanhamento dos pacientes e, conclama os oftalmologistas a tornarem-se mais perceptivos e se interessarem mais pelo tratamento das complicações oculares da hanseníase.

A sharp drop in the prevalence of leprosy occurred in the last three decades. However, the incidence has not decreased at the same rate. Three years after the World Health Organization last deadline for leprosy control, patients considered healed still need special care for their incapacities and immunopathological reactions. Medical literature reffers blindness in 4 percent to 11 percent of studied patients and more than 20 percent with severe visual problems due to corneal exposure, bacillary invasion and hipersensibility. These mechanisms result in a population of nearly one million blind leprosy patients even though official prevalence accounts no more than 250,000 patients worldwide. The author calls for better patients management and follow-up and urges ophthalmologists to become more aware and interested in the treatment of the ocular complications of leprosy.

Klebsiella pneumoniae endophthalmitis secondary to liver abscess presenting as acute iridocyclitis.

A 51-year-old man presented with acute iridocyclitis with no evidence of vitritis on B-scan that progressed to endogenous endophthalmitis. Systemic work-up revealed a large liver abscess. Urine, blood, liver abscess, and vitreous aspirate cultures all grew Klebsiella pneumoniae. The eye was enucleated secondary to severe pain from neovascular glaucoma and loss of vision.

Borrelia-associated crystalline keratopathy with intracorneal detection of Borrelia garinii by electron microscopy and polymerase chain reaction.

PURPOSE: First report of a patient with Borrelia-associated crystalline keratopathy with intracorneal evidence of Borrelia garinii by polymerase chain reaction (PCR) and electron microscopy (EM). METHODS: Report of a 67-year-old patient with medical history of recurrent iridocyclitis and arthritis presented with a bilateral, progressive, asymmetric crystalline keratopathy, which was particularly pronounced in the peripheral temporal superior cornea. After penetrating keratoplasty, crystalline keratopathy with stromal haziness recurred. Corneal regrafting was performed. The corneal specimen from the penetrating keratoplasty was examined by light and EM as well as by PCR. RESULTS: In the explanted corneal graft, as well as retrospectively in the corneal specimen from the first keratoplasty, spirochetelike bodies and fragments were detected by light and EM. Borrelia burgdorferi sensu lato DNA was demonstrated by broad-range (16S rDNA) PCR. A more precise identification as Borrelia garinii serotype 5 was possible by analyses of the flaB and ospA gene sequences. Borrelia-specific serological tests showed borderline titers in immunofluorescence and weak reaction in immunoblot, respectively. CONCLUSIONS: This case illustrates that borreliae must be considered as a cause of crystalline keratopathy; Borrelia-specific serological tests can be false negative; explanted cornea specimens of etiologically unclear crystalline keratopathy should be analyzed by EM or PCR for detection of pathogens; and prolonged antibiotic treatment might be effective to prevent progression or recurrence of the disease.

Lepromatous iridocyclitis.

A 36-year-old woman with no prior medical history presented with a unilateral decrease in vision and iridocyclitis to our hospital. External examination demonstrated multifocal, firm, elevated, non-tender skin nodules on the patient's face and left hand. In addition, slit-lamp biomicroscopy revealed gray, cheesy-appearing nodules on the iris surface of the affected eye. Anterior chamber paracentesis and pars plana vitrectomy did not reveal further information. Skin nodule biopsy, however, demonstrated multiple fragmented organisms within histiocytes, consistent with leprosy. The iridocyclitis resolved after treatment with dapsone, corticosteroids, and rifampin and her vision returned to 20/20.

Cat-scratch disease (ocular bartonellosis) presenting as bilateral recurrent iridocyclitis.

An otherwise healthy 9-year-old girl presented with bilateral recurrent anterior uveitis. Thirteen months later, the diagnosis of cat-scratch disease (ocular bartonellosis) was suspected when neuroretinitis appeared. Confirmation was based on serological test results positive for Bartonella henselae. Antibiotic treatment completely cured the disease, and there have been no further manifestations during a follow-up period of 6 years.

A case of infected scleral buckle with Mycobacterium chelonae associated with chronic intraocular inflammation.

PURPOSE: To describe a unique case of chronic intraocular inflammation secondary to scleral buckle infection with Mycobacterium chelonae that was successfully treated with buckle explantation. METHODS: Case report. RESULTS: A 59-year-old male with a history of retinal detachment repair at the age of 41 presented with chronic, recurrent intraocular inflammation responsive to topical corticosteroids. Conjunctival erosion with exposure of the scleral buckle occurred five months after initial presentation. The scleral buckle was removed and cultured. After three weeks of postoperative topical tobramycin and dexamethasone treatment, the patient has remained symptom-free without medications. The explanted material grew acid-fast bacilli later identified as M. chelonae. CONCLUSIONS: This case describes a new finding of chronic intraocular inflammation associated with a scleral buckle infected with M. chelonae and the successful resolution of extraocular infection and intraocular inflammation after buckle removal.

Ocular manifestations of Whipple disease: an atypical presentation.

A 62-year-old man developed bilateral granulomatous iridocyclitis after uncomplicated cataract surgery. On ophthalmic examination, we found moderate inflammation in the anterior chamber and vitreous, with granular crystalline deposits on the iris, intraocular lens, and capsular bag. Biopsy of the lens capsule and vitreous revealed periodic acid-Schiff-positive, diastase-resistant bacilli consistent with Tropheryma whippelii. Electron microscopy and polymerase chain reaction confirmed the diagnosis of Whipple disease. A jejunal biopsy specimen also revealed T whippelii. Treatment with trimethoprim-sulfamethoxazole, cefixime, rifampin, and doxycycline resulted in improvement of systemic symptoms, but intraocular inflammation persisted. Intraocular inflammation was eventually reduced with the intravenous administration of ceftriaxone sodium.

Intraocular coccidioidomycosis diagnosed by skin biopsy.

OBJECTIVE: To describe ocular findings in 2 patients with disseminated coccidioidomycosis diagnosed by skin biopsy. METHODS: The clinical and histopathologic findings of the 2 patients were reviewed retrospectively. RESULTS: One patient had a unilateral, granulomatous iridocyclitis with multiple iris nodules and a large vascularized anterior chamber mass, in the setting of pulmonary, cutaneous, and skeletal infection by Coccidioides immitis. The second patient developed papilledema and multifocal chorioretinitis accompanied by pulmonary, cutaneous, and meningeal C immitis infection. In each case, examination of the skin biopsy specimen revealed C immitis spherules. Treatments included local and systemic amphotericin B and oral fluconazole. CONCLUSIONS: Although rare, intraocular involvement can occur in the setting of disseminated coccidioidomycosis. A thorough systemic evaluation and biopsy of suspicious skin lesions can aid in the diagnosis.

Bilateral iridocyclitis caused by Mycobacterium leprae diagnosed through paracentesis.

The authors conducted an anterior chamber paracentesis in a patient with lepromatous leprosy showing bilateral iridocyclitis. The paracentesis was performed in the outpatients department. The aqueous humor was studied by Ziehl-Nielsen staining method and the result was the isolation of the M. leprae in the anterior chamber. This study shows that M. leprae can promote uveitis in leprosy patients. Therefore, it should be looked for in patients having this type of disease.

[A case of corneal mycosis]. / Consideratii asupra unui caz de micoza corneana.

A case of corneal ulcer in the right eye and iridocyclitis of the left eye, with mycotic ethiology in a 50 year woman who works in humid conditions with undefinite organic compounds. The diagnostic has been put through laboratory tests (direct frotee and culture). After the treatment with antimycotics the lesions have been epithelised, the patient leaving the hospital with good vision (VOD = 2/3, VOS = 1/3). After two years, in the picture of a sicca syndromme, the condition reappears in the left eye, the ulcer has perforated needing conjunctival covering.

[Differential diagnosis of tuberculous and herpetic uveitis]. / K differentsial'noi diagnostike tuberkuleznykh i gerpeticheskikh uveitov.

A total of 158 inpatients with ophthalmic tuberculosis or with this condition suspected were examined at the St. Petersburg Research Institute of Phthisiopulmonology. Tuberculous etiology of iridocyclitis and chorioretinitis was confirmed in 39 patients, herpesvirus etiology was recognized in 35 patients. In the rest patients endogenous uveitis or dystrophic involvement of the eye of other origin were diagnosed. An algorithm of differential diagnosis tuberculous and herpetic uveitis of different localization has been developed, which is based on the clinical findings and results of tuberculin tests, allergic test with herpetic polyvaccine, relevant test therapies, and cytologic investigations of the conjunctival epithelium. The results confirm the differential diagnostic significance of this scheme and a high specificity of focal reactions in allergic tests after A. A. Kasparov in patients with herpesvirus uveitis.

Coccidioidomycosis iridocyclitis.

BACKGROUND: Coccidioidomycosis has reached epidemic proportions in the southwest region of the United States. Despite the greater numbers of cases, isolated anterior segment ocular coccidioidomycosis in the absence of systemic infection continues to be rare, although its incidence may be increasing. METHODS: Two patients without clinical evidence of systemic disease and one patient with previously treated pulmonary coccidioidomycosis had granulomatous iridocyclitis and iris nodules that were unresponsive to corticosteroid therapy. All three patients underwent iris biopsy, anterior chamber tap, and washout for histopathologic diagnosis of anterior segment disease, and all subsequently received systemic antifungal therapy. Two patients also received multiple intraocular injections of amphotericin B. RESULTS: Papanicolaou and hematoxylin-eosin-stained preparations of anterior chamber tap and biopsies of the iris in each of these patients showed fibrinopurulent or granulomatous inflammatory exudate with intact and disrupted Coccidioides spherules. Despite aggressive systemic and intraocular therapy, one patient required enucleation for a blind, painful eye. The other two patients continue to have limited visual acuity but with at least partial resolution of the intraocular lesions. CONCLUSIONS: Ocular coccidioidomycosis without clinical evidence of systemic involvement is rare. Isolated anterior segment disease is also uncommon; however, because of the current epidemic in the southwest region of the United States, ocular coccidioidomycosis should be considered in any patient who traveled through or lived in endemic areas and who has a granulomatous iridocyclitis associated with iris mass that is unresponsive to corticosteroid therapy.

[Iris tuberculosis. A propos of a case diagnosed by iridectomy]. / Tuberculose irienne. A propos d'une observation diagnostiquée par iridectomie.

Ocular tuberculosis is currently rare in developed countries. We report a case of tuberculous nodular anterior uveitis which revealed primary tuberculosis in a 2-year old girl. This diagnosis was established on microscopic examination of a surgical iridectomy specimen. Thus, a metastatic retinoblastoma was eliminated. The subsequent clinical investigations showed that the girl's father had active pulmonary tuberculosis.