RESUMO
Ethambutol is frequently used in the treatment of tuberculosis, and, although optic neuropathies have been reported with the use of ethambutol, this adverse side effect has been considered to be rare and generally reversible with discontinuation of the medication. However, we recently saw two patients with renal tuberculosis treated with ethambutol in whom visual loss from toxic optic neuropathies was severe and irreversible despite careful ophthalmological monitoring and prompt discontinuation of the agent at the first sign of impaired visual function. While ethambutol treatment is most commonly instituted for pulmonary tuberculosis, it is interesting to note that both of these patients had renal tuberculosis. Since ethambutol is actively excreted via the renal system, compromise of renal function such as due to renal tuberculosis may lead to serum concentration elevations of ethambutol sufficient to produce optic neuropathy.
Assuntos
Etambutol/efeitos adversos , Neurite Óptica/induzido quimicamente , Tuberculose Renal/tratamento farmacológico , Adulto , Idoso , Etambutol/uso terapêutico , Feminino , Angiofluoresceinografia , Humanos , Masculino , Pessoa de Meia-Idade , Acuidade Visual/efeitos dos fármacos , Campos Visuais/efeitos dos fármacosRESUMO
Breast carcinoma metastatic to the orbit presented in four patients as a diffuse mass lesion. Clinical findings included restricted ocular motility, palpable mass, enophthalmos, and ptosis. The delay in diagnosis in three cases was due to subtle early findings, the long time interval from the primary breast lesion, lack of other metastases, and, in each of the four cases, the patient's reluctance to disclose any history of breast disease. Pathologic examination of the orbital breast metastases revealed two types: an adenocarcinomatous pattern with nests of pleomorphic malignant appearing cells and a histiocytoid variant with bland, large cells similar to histiocytes.
