Pediatric Posterior Infectious Uveitis.

PURPOSE: To describe the most important cause of infectious posterior uveitis in pediatric patients. METHODS: Review of the literature. RESULTS: The most important causes of infectious uveitis in pediatric patients are: cat-scratch disease, toxocariasis, tuberculosis, viral diseases and toxoplasmosis. Ocular manifestations include retinitis, neuroretinitis, choroidal granulomas, peripheral granulomas and posterior pole granulomas. CONCLUSION: Infectious posterior uveitis is a challenging subject and should be considered in the differential diagnosis of any posterior uveitis in children. Infectious uveitis must be excluded before initiating immunosuppressive therapy.

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.

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

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.

La neurorretinitis como manifestación de la enfermedad por arañazo de gato se presenta en el 1-2 % de los pacientes con afecciones oculares por Bartonella 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.

Acute retinal pigment epitheliitis: a case presentation and literature review.

Acute retinal pigment epitheliitis (ARPE) is an idiopathic, self-limiting inflammatory retinal disorder that particularly affects healthy young individuals. The characteristic fundoscopic appearance of the acute retinal pigment epitheliitis includes a fine pigment stippling surrounded by a yellow-white hypopigmented halos in the macula. Although the exact pathogenesis of the disease remains unknown, some reports have suggested a relationship between a viral infection and acute retinal pigment epitheliitis. Acute retinal pigment epitheliitis is a rare disorder, and only single case reports or case series are found in the literature. The clinical and demographic characteristics of patients with this disease are not fully understood because of its rarity. In this study, we searched the literature to collect clinical and demographic features of the reported cases. We detail the characteristics of acute retinal pigment epitheliitis were pointed and discuss the pathogenesis of the disease.

PRESUMED TUBERCULOUS MULTIFOCAL RETINITIS IN PATIENTS UNDER TREATMENT WITH BIOLOGIC AGENTS.

PURPOSE: To report unique retinal fundus lesions and treatment outcomes of intraocular tuberculosis in patients under anti-tumor necrosis factor treatment. METHODS: Retrospective review of two patients with laboratorial evidence of tuberculosis who had bilateral ocular signs and symptoms not attributable to other diseases. Multimodal imaging was analyzed at the time of presentation and after the treatment initiation. The study patients underwent standard treatment for tuberculosis. RESULTS: Clinical and laboratory findings were consistent with the diagnosis of presumed tuberculosis. Color fundus photograph revealed the presence of multifocal yellowish retinal spots in the study eyes. On fluorescein angiography, the retinal lesions seen on color fundus photograph showed early hypofluorescence with progressive staining of its edges. Occlusive vasculitis with peripheral nonperfusion was also observed in both cases. Spectral domain optical coherence tomography demonstrated increased reflectivity and thickness on the topography of retinitis lesions. After specific antibiotic treatment for tuberculosis, there was complete disappearance of the retinal lesions in all study eyes. CONCLUSION: We report two unique cases of bilateral presumed intraocular tuberculosis presenting as multifocal retinitis in patients under biologic agent treatment. Anti-tumor necrosis factor agents may be related to unusual fundus manifestations of tuberculosis.

Diffuse Unilateral Subacute Neuroretinitis Evolving With Submacular Granuloma.

DUSN is an infectious ocular disease that can lead to severe visual impairment and blindness. It usually occurs in young healthy individuals and depending on the stage of the disease, clinical presentation may range from mild vitritis and multifocal gray-white lesions in outer retina to optic atrophy.Parasites of different sizes and species have been proposed as the etiological agent of this disease. Thus, it is hypothesized that different infectious worms may be considered as the likely cause of a both autoimmune and toxic form of nematode retinopathy.Most patients present with already severe visual impairment and in the later stages of the disease, where the likelihood of improvement is low, despite therapy. In cases of early diagnosis, prompt treatment, whether with oral antihelmintic or direct photocoagulation of the worm, patients may show considerable visual improvement and have a more favorable prognosis.

Infección atípica y neurorretinitis por Bartonella henselae en una unidad de hospitalización pediátrica: comunicación de tres casos / Bartonella henselae with atypical infection and neuroretinitis in a pediatric unit: report of three cases

Resumen Bartonella henselae es el agente etiológico de la enfermedad por arañazo de gato (EAG), infección endémica en Chile. Típicamente se presenta como una linfadenopatía regional autolimitada y menos frecuentemente con compromiso sistémico y manifestaciones extraganglionares: en hígado, bazo, hueso, ojo, entre otros. Se presentan tres casos de infección atípica por Bartonella henselae en las que se evidenció compromiso ocular, manifestado como una neurorretinitis. Esta revisión destaca la importancia de la búsqueda activa de complicaciones oculares en pacientes con compromiso sistémico por Bartonella henselae, implicando un cambio en el tratamiento y pronóstico de la enfermedad.

Abstract Bartonella henselae is cat scratch disease's etiological agent, which is considered an endemic infection in Chile. It typically presents as a self-limited regional lymphadenopathy and less frequently with systemic involvement and extranodal or atypical manifestations: hepatosplenic, ocular or musculoskeletal involvement, among others. We present three cases of atypical cat scratch disease with ocular compromise, as neurorretinitis. This review highlights the importance of the active search for ocular complications in patients with disseminated cat scratch disease, leading to possible change in treatment and prognosis of the disease.

A case of Bartonella neuroretinitis with macular star diagnosed by clinical, epidemiological, serological, and molecular data: resolution after initiation of antimicrobial therapy.

The differential diagnosis of optic neuritis is broad and varied. We report the case of a 24-year-old Brazilian man who presented with five-week history of fever, malaise, myalgia, severe fatigue, tender right preauricular lymphadenopathy, and acute vision blurring associated with right optic disc swelling and exudates in a macular star pattern. His illness developed soon after an infestation of fleas broke out among his cats. Diagnosis of ocular bartonellosis was confirmed by serological and molecular analyses targeting amplification of Bartonella spp. htrA gene. Signs and symptoms only improved after initiation of antimicrobial therapy.

UNILATERAL NEURORETINITIS AS A LATE-ONSET MANIFESTATION OF THE CHIKUNGUNYA FEVER: A CASE SERIES.

PURPOSE: To report 3 cases of unilateral neuroretinitis associated with the chikungunya fever (CHIKV). METHODS: Retrospective noncomparative case series. RESULTS: Three female patients with similar complains of blurry vision and decreased visual acuity that started several weeks after experiencing symptoms of the CHIKV. All patients had decreased best-corrected visual acuity and distortion on the Amsler grid in the affected eye. Evidence of unilateral optic nerve swelling and macular exudates was noted in all patients. No pharmacologic therapy was given. At 2-month follow-up evaluation, all patients had regained at least 3 lines in the Snellen chart, and subretinal fluid and optic nerve swelling had resolved. CONCLUSION: Unilateral neuroretinitis can present as a late-onset manifestation of CHIKV. Three patients with diagnosis of CHIKV developed unilateral neuroretinitis weeks after the acute viral syndrome, suggesting a possible immunological etiology for this manifestation. To our knowledge, this is the first case series of CHIKV leading to neuroretinitis in the Western World.

[Bartonella henselae with atypical infection and neuroretinitis in a pediatric unit: report of three cases]. / Infección atípica y neurorretinitis por Bartonella henselae en una unidad de hospitalización pediátrica: comunicación de tres casos.

Bartonella henselae is cat scratch disease's etiological agent, which is considered an endemic infection in Chile. It typically presents as a self-limited regional lymphadenopathy and less frequently with systemic involvement and extranodal or atypical manifestations: hepatosplenic, ocular or musculoskeletal involvement, among others. We present three cases of atypical cat scratch disease with ocular compromise, as neurorretinitis. This review highlights the importance of the active search for ocular complications in patients with disseminated cat scratch disease, leading to possible change in treatment and prognosis of the disease.

A case of Bartonella neuroretinitis with macular star diagnosed by clinical, epidemiological, serological, and molecular data: resolution after initiation of antimicrobial therapy

Abstract The differential diagnosis of optic neuritis is broad and varied. We report the case of a 24-year-old Brazilian man who presented with five-week history of fever, malaise, myalgia, severe fatigue, tender right preauricular lymphadenopathy, and acute vision blurring associated with right optic disc swelling and exudates in a macular star pattern. His illness developed soon after an infestation of fleas broke out among his cats. Diagnosis of ocular bartonellosis was confirmed by serological and molecular analyses targeting amplification of Bartonella spp. htrA gene. Signs and symptoms only improved after initiation of antimicrobial therapy.

Further observations on a bilateral IRVAN syndrome case.

PURPOSE: Reporting clinical features of the late course of the disease after long-term follow-up in a bilaterally affected patient with idiopathic retinitis, vasculitis, retinal aneurysms and neuroretinitis (IRVAN) and new peripheral retinal findings on wide-field angiography and multimodal imaging. METHODS: This was a retrospective observational study, based on current diagnostic studies including wide-field fluorescein angiography, optical coherence tomography (OCT) and treatment of aneurysms with argon laser photocoagulation. RESULTS: A 21-year-old female with bilateral IRVAN syndrome-stage 2 in the right eye and stage 3 in the left eye-previously treated bilaterally with laser photocoagulation for retinal macroaneurysms and ischemic areas between 1985 and 1992. Follow-up interrupted on two occasions, with subsequent fundus re-examinations confirming the prevention of retinal neovascularization in both eyes, as recently evidenced on wide-field angiography. CONCLUSIONS: A case of bilateral IRVAN disease with multiple retinal aneurysms, neuroretinitis and peripheral capillary nonperfusion successfully treated with laser photocoagulation, maintaining normal visual acuity in one eye and preventing retinal neovascular complications.

Recurrent idiopathic neuroretinitis as a spectrum of atypical optic neuritis: a case report and literature review.

Recurrent idiopathic neuroretinitis is an inflammatory optic neuropathy characterized by optic nerve edema and macular star, associated with painless and recurrent episodes of visual loss, poor visual prognosis, and visual field defects related to nerve fiber layer injury. The disorder is sometimes mistaken for atypical optic neuritis. However, early diagnosis is important for visual recovery. Long-term immunosuppression has been shown to reduce the rate of recurrence and protect against severe and irreversible vision loss.

Recurrent idiopathic neuroretinitis as a spectrum of atypical optic neuritis: a case report and literature review / Neurorretinite recorrente idiopática como espectro da neurite óptica atípica: relato de caso e revisão da literatura

ABSTRACT Recurrent idiopathic neuroretinitis is an inflammatory optic neuropathy characterized by optic nerve edema and macular star, associated with painless and recurrent episodes of visual loss, poor visual prognosis, and visual field defects related to nerve fiber layer injury. The disorder is sometimes mistaken for atypical optic neuritis. However, early diagnosis is important for visual recovery. Long-term immunosuppression has been shown to reduce the rate of recurrence and protect against severe and irreversible vision loss.

RESUMO Neurorretinite recorrente idiopática é uma neuropatia óptica inflamatória caracterizada por edema do nervo óptico e estrela macular associada a episódios recorrentes de perda visual indolor, baixo prognóstico visual e desfeitos de campo visual relacionados a injúria da camada de fibras nervosas. Essa condição pode ser confundida com neurite óptica atípica e seu correto diagnóstico é importante para o prognóstico visual, uma vez que a imunossupressão continua previne episódios recorrentes que podem levar a perda visual severa e irreversível.

Toxoplasmosis ocular recurrente. Presentación de 3 casos y revisión de la literatura / RECURRENT OCULAR TOXOPLASMOSIS: REPORT OF 3 PATIENTS AND REVISION OF THE LITERATURE

La toxoplasmosis ocular recurrente es la forma más común de toxoplasmosis ocular. Las lesiones se localizan adyacentes a una cicatriz coriorretinal resultado de una infección previamente adquirida. La retinitis por toxoplasma provoca una respuesta inflamatoria variable, ocasionando vasculitis, vitreítis, coroiditis y uveítis anterior. El diagnóstico se realiza examinando el fondo de ojo, y su etiología debe considerarse cuando en un adulto joven inmunocompetente, se observa en la fundoscopía la presencia de una lesión retinal focal, asociada a una cicatriz coriorretinal. La retinografía permite documentar los hallazgos observados en el fondo de ojo. El examen serológico para identificar anticuerpos anti toxoplasma de clase IgM e IgG solo confirma la exposición al parásito pero no constituyen pruebas diagnósticas confirmatorias. Se presentan 3 casos de toxoplasmosis ocular recurrente en pacientes adultos cuyos diagnósticos se realizaron mediante el examen fundoscópico y la retinografía.

Recurrent ocular toxoplasmosis is the most common form of ocular toxoplasmosis. Lesions are located adjacent to a chorioretinal scar as a result of a previously acquired infection. Toxoplasma retinitis produces a variables inflammatory response, leading to vasculitis, vitreitis, choroiditis and anterior uveities. Diagnosis is performed by fundoscopy and its ethiology must be considered when fundoscopy shows the presence of a focal retinal lesion associated to a chorioretinal scar in a young immunocompetent adult. Retinography allows documenting findings from the fundoscopy. Serological examination to identify anti toxoplasma antibodies classes IgM and IgG only confirms exposure to the parasite but do not constitute confirmatory diagnostic evidence. We present 3 cases of recurrent ocular toxoplasmosis in adult patients that were diagnosis by fundoscopic examination and retinography

BARTONELLA QUINTANA-ASSOCIATED NEURORETINITIS: LONGITUDINAL SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHIC FINDINGS.

PURPOSE: To report an unusual case of neuroretinitis caused by Bartonella quintana and its spectral-domain optical coherence tomographic (SD-OCT) features. METHODS: A 12-year-old girl presented with unilateral neuroretinitis with stellate maculopathy. Bartonellosis was confirmed after serologic testing for antibodies to B. quintana. RESULTS: Color photograph of the right eye revealed papillitis and stellate macular exudation. spectral-domain optical coherence tomography of the right eye revealed hyperreflective dots in the outer nuclear and outer plexiform layers, as well as disruption and loss of the external limiting membrane, ellipsoid zone, and interdigitation zone in the foveal area. CONCLUSION: The authors report an unusual case of neuroretinitis by B. quintana and its spectral-domain optical coherence tomographic findings.