Sucessfull management of bilateral presumed Candida endogenous endophtalmitis following pancreatitis / Tratamento bem sucedido de caso de endoftalmite endógena bilateral presumida por Candida pós pancreatite

ABSTRACT Endogenous endophthalmitis is a rare, and frequently devastating, ophthalmic disease. It occurs mostly in immunocompromised patients, or those with diabetes mellitus, cancer or intravenous drugs users. Candida infection is the most common cause of endogenous endophthalmitis. Ocular candidiasis develops within days to weeks of fungemia. The association of treatment for pancreatitis with endophthalmitis is unusual. Treatment with broad-spectrum antibiotics and total parenteral nutrition may explain endogenous endophthalmitis. We report the case of a patient with pancreatitis treated with broad-spectrum antibiotics and total parenteral nutrition who developed bilateral presumed Candida endogenous endophthalmitis that was successfully treated with vitrectomy and intravitreal amphotericin B.

RESUMO Endoftalmite endógena é uma condição oftalmológica rara e frequentemente devastadora. Ocorre principalmente em pacientes imunocomprometidos, diabéticos, com neoplasias ou usuários de drogas intravenosas. Infecção por Candida é a causa mais comum de endoftalmite endógena. A candidíase ocular ocorre de dias a semanas após a fungemia. A associação de endoftalmite e o tratamento para pancreatite é rara. O tratamento com antibióticos de amplo espectro e alimentação parenteral total podem explicar uma endoftalmite endógena. Neste estudo, reportamos o caso de um paciente com pancreatite tratado com antibióticos de amplo espectro e alimentação parenteral total que desenvolveu endoftalmite endógena bilateral presumida por Candida que foi tratado com sucesso com vitrectomia e injeção intravítrea de amfotericina B.

Intraretinal hemorrhage associated with visceral leishmaniasis / Hemorragia intrarretiniana associada à leishmaniose visceral

ABSTRACT Visceral Leishmaniasis, also know as Kala-azar, is a parasitic tropical disease caused by protozoa of the genus Leishmania donovani. It is an endemic disease in many countries. It affects approximately 1,5 million people every year, and when associated with mal-nutrition and co-infection it may be fatal. Fever, hepatosplenomegaly, and pancytopenia is its typical clinical picture. Ocular manifestations of Kalaazar are relatively rare and can affect either anterior or posterior segment of the eye. We report a patient with kala-azar presenting intraretinal hemorrhages that regress completely after the successful treatment for visceral leishmaniasis.

RESUMO Leishmaniose visceral, também conhecida como calazar é uma doença tropical parasitária, causada pelo protozoário do gênero Leishmania donovan uma doença endêmica em muitos países. Afeta aproximadamente 1,5 milhões de pessoas durante todo ano e quando associada à desnutrição e coinfecção pode ser fatal. Febre, hepatoesplenomegalia e pancitopenia e o quadro típico. Manifestações oculares são raras e podem afetar tanto o segmento anterior como o posterior do olho. Relatamos o caso de um paciente com calazar e hemorragia intrarretiniana que regrediu após tratamento para leishmaniose visceral.

Branch retinal artery occlusion in Susac's syndrome

Susac's syndrome is a rare disease attribuited to a microangiopathy involving the arterioles of the cochlea, retina and brain. Encefalopathy, hearing loss, and visual deficits are the hallmarks of the disease. Visual loss is due to multiple, recurrent branch arterial retinal occlusions. We report a case of a 20-year-old women with Susac syndrome presented with peripheral vestibular syndrome, hearing loss, ataxia, vertigo, and vision loss due occlusion of the retinal branch artery.

Síndrome de Susac é uma microangiopatia rara que afeta as arteríolas da cóclea, retina e encéfalo. Encefalopatia, perda auditiva e baixa da acuidade visual formam a tríade clássica da doença. A baixa de acuidade visual ocorre devido a múltiplas e recorrentes oclusões de ramo arterial da retina. Relatamos o caso de uma paciente de 20 anos com síndrome de Susac apresentando síndrome vestibular periférica, perda auditiva, vertigem, ataxia e baixa da acuidade visual por oclusão de ramo arterial de retina.

Evaluation of hemostasis disorders and anticardiolipin antibody in patients with severe leptospirosis.

A prospective study was designed to evaluate disorders of hemostasis and levels of anticardiolipin antibodies (ACL) in 30 patients with severe leptospirosis and acute renal failure (ARF) (ARF was defined as serum creatinine > or =1.5 mg/dL). The patients had been admitted to the Walter Cantídio University Hospital, São José Infectious Diseases Hospital and General Hospital of Fortaleza, Ceará, from August 1999 to July 2001. They all were male, with a mean age of 32 +/- 14 years and with clinical and laboratory diagnoses of ARF leptospirosis. The time elapsed between onset of symptoms and the first hemorrhagic manifestation was 9 +/- 4 days. Bleeding was observed in 86% of the patients. Laboratory tests showed significantly high levels of urea (181 +/-95 mg/dl), fibrinogen, (515 +/- 220 mg/dl), prothrombin time (13.3 +/- 0.9 seconds) and low platelet counts (69 +/- 65 x 10(3)/mm3) on admission. There was no elevation in activated partial thromboplastin time or thrombin time. Levels of IgM and IgG ACL concentrations were significantly increased (p < 0.05) in leptospirosis patients when compared to control patients (28.5 +/- 32.4 vs. 11.5 +/- 7.9MPL U/ml and 36.7 +/- 36.1 vs. 6.5 +/- 2.5 GPL U/ml), respectively. Vasculitis, thrombocytopenia and uremia should be considered important factors for the pathogenesis of hemorrhagic disturbances and the main cause of death in severe leptospirosis.

Evaluation of hemostasis disorders and anticardiolipin antibody in patients with severe leptospirosis

A prospective study was designed to evaluate disorders of hemostasis and levels of anticardiolipin antibodies (ACL) in 30 patients with severe leptospirosis and acute renal failure (ARF) (ARF was defined as serum creatinine > or = 1.5 mg/dL). The patients had been admitted to the Walter Cantídio University Hospital, Säo José Infectious Diseases Hospital and General Hospital of Fortaleza, Ceará, from August 1999 to July 2001. They all were male, with a mean age of 32 + or - 14 years and with clinical and laboratory diagnoses of ARF leptospirosis. The time elapsed between onset of symptoms and the first hemorrhagic manifestation was 9 + or - 4 days. Bleeding was observed in 86 percent of the patients. Laboratory tests showed significantly high levels of urea (181 + or - 95 mg/dl), fibrinogen, (515 + or - 220 mg/dl), prothrombin time (13.3 + or - 0.9 seconds) and low platelet counts (69 + or - 65x10³/mm³) on admission. There was no elevation in activated partial thromboplastin time or thrombin time. Levels of IgM and IgG ACL concentrations were significantly increased (p < 0.05) in leptospirosis patients when compared to control patients (28.5 + or - 32.4 vs. 11.5 + or - 7.9MPL U/ml and 36.7 + or - 36.1 vs. 6.5 + or - 2.5 GPL U/ml), respectively. Vasculitis, thrombocytopenia and uremia should be considered important factors for the pathogenesis of hemorrhagic disturbances and the main cause of death in severe leptospirosis