RESUMO
An 85-year-old, immunocompetent man was referred to the authors due to the presence of an enlarging, pigmented mass of the conjunctiva concerning for a conjunctival melanoma. Wide excision of the mass revealed a pigmented or "dematiaceous" fungus. He was treated with topical natamycin, and the lesion healed well without any evidence of recurrence. Dematiaceous fungi should be considered in the differential for pigmented conjunctival lesions.
Assuntos
Doenças da Túnica Conjuntiva/diagnóstico , Neoplasias da Túnica Conjuntiva/diagnóstico , Exophiala/isolamento & purificação , Infecções Oculares Fúngicas/diagnóstico , Melanoma/diagnóstico , Feoifomicose/diagnóstico , Idoso de 80 Anos ou mais , Terapia Combinada , Doenças da Túnica Conjuntiva/terapia , Crioterapia , Diagnóstico Diferencial , Infecções Oculares Fúngicas/terapia , Humanos , Masculino , Procedimentos Cirúrgicos Oftalmológicos , Feoifomicose/terapiaRESUMO
A patient with systemic cytomegalovirus (CMV), including chorioretinitis, received localized and systemic ganciclovir, systemic cidofovir analog, and localized foscarnet. Mutations conferring ganciclovir and cidofovir resistance were detected in CMV from the aqueous fluid but not in CMV from plasma. Quantifying CMV from aqueous fluid was valuable for monitoring the clinical response and predicting resistance.
Assuntos
Antivirais/administração & dosagem , Retinite por Citomegalovirus/virologia , Citomegalovirus/efeitos dos fármacos , Citomegalovirus/isolamento & purificação , Farmacorresistência Viral , Ganciclovir/administração & dosagem , Plasma/virologia , Adulto , Antivirais/farmacologia , Cidofovir , Citomegalovirus/genética , Citosina/administração & dosagem , Citosina/análogos & derivados , DNA Viral/genética , Olho/virologia , Feminino , Foscarnet/administração & dosagem , Ganciclovir/farmacologia , Humanos , Organofosfonatos/administração & dosagem , Análise de Sequência de DNARESUMO
An 11-year-old boy presented with progressive right-sided proptosis and an orbital mass on neuroimaging. Incisional biopsy revealed an epithelioid hemangioma. The patient underwent an orbitotomy with subtotal excision of the mass. However, the tumor recurred and progressed to the cavernous sinus, despite oral steroids, tacrolimus, and a second subtotal excision. Because of encouraging results reported with beta-blockers in the treatment of pediatric capillary hemangiomas, the patient was subsequently started on oral propranolol, 2 mg/kg/day, with discontinuation of steroids and tacrolimus. A rapid and impressive interval decrease in tumor size was observed, with improvement in proptosis and exposure keratopathy. The patient remains without recurrence approximately 9 months after initiation of propranolol. Our results suggest that oral propranolol may be a potential alternative therapy when complete excision of an epithelioid hemangioma is not practical.
