RESUMO
PURPOSE: Birdshot chorioretinopathy is currently treated with either systemic immune modulation or intravitreal polytherapy. These regimens pose challenges to the clinician and patient such as adverse effects, chronic treatment and compliance, and failure of therapy. In a patient with birdshot chorioretinopathy and juxtaposed cystoid macular edema, the authors assessed the efficacy of bevacizumab for treatment after systemic therapy had failed. METHODS: A 48-year-old woman was injected with intravitreal bevacizumab 10 times in her right eye with 4 weeks to 6 weeks intervening between injections. Improvement was monitored by best-corrected visual acuity and ocular coherence tomography. RESULTS: Visual acuity improved from 20/200 to 20/30 in the right eye, and foveal thickness improved from 638 µm to 200 µm. Visible signs of macular edema and inflammation completely disappeared. CONCLUSION: Bevacizumab monotherapy may improve visual acuity with resolution of macular edema in patients with birdshot chorioretinopathy that is refractory to traditional systemic therapy.
RESUMO
Tungiasis is a cutaneous infestation caused by the burrowing flea, Tunga penetrans. This infection typically results in the development of one or more wart-like fibrous papulonodules. The causative flea is endogenous to Central and South America, sub-Sarahan Africa and portions of India; consequently, tungiasis is rarely reported in North America. However, because of increasing air travel to and from endemic areas due to business and pleasure, it is imperative that this entity remain in the differential diagnosis when evaluating clinically suggestive lesions in a patient who also has a history of recent travel. We report a case of tungiasis in a 24-year-old Caucasian woman who presented with 7-week history of a non-healing, eroded nodule on the medial aspect of her left great toe. Significant history included travel to Tanzania during three months immediately prior to presentation. Following the presumptive clinical diagnosis of tungiasis, surgical removal of the flea and its contents was performed and the base of the lesion was curetted, without complication. The specimen was sent for histopathologic correlation which confirmed the diagnosis.
