Bilateral Ocular Rosai-Dorfman Disease Presenting as Diffuse Anterior Scleritis with Multiple Enlarging Epibulbar Masses.

PURPOSE: To report a unique case of extranodal Rosai-Dorfman disease (RDD) presenting as bilateral scleritis, which progressed to multifocal epibulbar masses. METHODS: Retrospective chart review. RESULTS: A 35-year-old Asian man presented with progressive pain and redness in both eyes for 4 months. Examination revealed bilateral diffuse scleral congestion and areas of scleral thinning. The cornea and anterior chamber of each eye were unremarkable. Despite oral corticosteroid and immunosuppressive treatment, scleritis progressed to multifocal epibulbar masses. Tissue biopsy specimens revealed foamy macrophages with histiocytes staining positive for CD68 and S100, confirming a diagnosis of RDD. Systemic evaluation was unremarkable for lymphadenopathy or extranodal involvement. The patient was started on systemic chemotherapy and at last follow up after 1 year, all epibulbar lesions were completely resolved. CONCLUSIONS: Rosai-Dorfman disease can present as bilateral scleritis initially and develop epibulbar masses without any systemic involvement. Biopsy with immunohistochemical analysis can aid in the diagnosis.

Voriconazole Induced Ocular Surface Dysplasia - Report of Two Cases.

PURPOSE: To report ocular surface dysplasia induced by voriconazole treatment in two patients with recalcitrant fungal keratitis. METHODS: Observational study. RESULTS: Case 1 - A 49 year old female who was a known case of fungal keratitis and treated with prolonged topical voriconazole therapy, underwent penetrating keratoplasty and the histopathological examination of corneal specimen showed multiple keratin pearls with dyskeratotic cells suggestive of squamous cell carcinoma.Case 2 - A 78-year-old man who was diagnosed as fungal keratitis in his left eye and treated with topical voriconazole 1% and itraconazole 1% for 6 months underwent therapeutic penetrating keratoplasty. Histopathology of the host corneal tissue showed squamous cells with irregular thickening with dyskeratotic cells and squamous eddies suggestive of voriconazole induced dysplasia. CONCLUSION: Prolonged topical voriconazole treatment in fungal keratitis can induce ocular surface dysplasia. Early diagnosis and treatment of the dysplastic changes can result in complete remission and prevent recurrence.

An Unusual Branching Pattern of the Median Cubital Vein and its Relations with Lateral Cutaneous Nerve of Forearm in the Upper Extremity: Anatomicoclinical Notes

Cubital fossa is the usual site for performing venepuncture in the clinical settings for health screenings and diagnostic purposes. This procedure is simple and uncomplicated but occasionally can lead to bleeding and pain in the form of complex regional pain syndrome. Superficial veins of the upper limb are often used for venepuncture for transfusion purposes and for obtaining blood samples. These veins are also used for cardiac catheterisation and giving intravenous injections. During routine cadaveric dissection, a cubital venous variation was observed in a 45-yr –old, male cadaver. The median cubital vein initiated from cephalic vein passed upwards and laterally superficial to posterior branch of medial cutaneous nerve of forearm. In the middle of its course, it gave off an ascending channel which further divided into medial and lateral tributaries. The medial tributary terminated into the basilic vein, whereas the lateral tributary ascended laterally superficial to a branch of lateral cutaneous nerve of forearm and drained into cephalic vein at the level of elbow joint. Various patterns of superficial cubital veins have been mentioned in literature. Awareness of such anatomical variations is crucial while performing venepuncture in clinical settings as well as for creating arteriovenous fistulas for hemodialysis purpose.