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Idiopathic sclerosing dacryoadenitis. 特发性硬化性泪腺炎。
IF 2.9 Q2 Medicine Pub Date : 2023-09-19 DOI: 10.1186/s12348-023-00365-y
Samantha D Butterfield, Rona Z Silkiss

Dacryoadenitis is an inflammation of the lacrimal gland. This condition has an extensive differential diagnosis, requiring a thorough workup to identify the underlying etiology. If no etiology is identified, the condition is termed idiopathic dacryoadenitis. The purpose of this report is to present a case of idiopathic sclerosing dacryoadenitis and review the diagnostic process.We present a case of sclerosing dacryoadenitis non responsive to systemic antibiotics and steroids, improving after surgical debulking/biopsy. Systemic inflammatory and infectious labs were negative. Tissue was negative for SARS-CoV-2 antigen. Histopathologic review of the surgical specimen revealed nonspecific, sclerosing dacryoadenitis, ultimately supporting the diagnosis of idiopathic nonspecific fibrosing dacryoadenitis.This case reviews the presentation, evaluation, and management of a common orbital pathologic condition, with updated recommendations based on the most current literature.

泪腺腺炎是一种泪腺炎症。这种情况有广泛的鉴别诊断,需要彻底检查以确定潜在的病因。如果没有确定病因,这种情况被称为特发性泪腺炎。本报告的目的是提出一例特发性硬化性泪腺炎,并回顾其诊断过程。我们报告了一例对全身抗生素和类固醇无反应的硬化性泪腺炎,在手术拆封/活检后有所改善。全身炎症和感染实验室均为阴性。组织对严重急性呼吸系统综合征冠状病毒2型抗原呈阴性。手术标本的组织病理学检查显示非特异性硬化性泪腺炎,最终支持特发性非特异性纤维化泪腺炎的诊断。本病例回顾了常见眼眶病理状况的表现、评估和管理,并根据最新文献提出了最新建议。
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引用次数: 0
Ocular sarcoidosis in adults and children: update on clinical manifestation and diagnosis. 成人和儿童眼部结节病:临床表现和诊断的最新进展。
IF 2.9 Q2 Medicine Pub Date : 2023-09-18 DOI: 10.1186/s12348-023-00364-z
Magdalena Bazewicz, Jarmila Heissigerova, Carlos Pavesio, François Willermain, Janusz Skrzypecki

Sarcoidosis-associated uveitis, is the predominant ocular sarcoidosis presentation, which affects both adults and children. For adults, international ocular sarcoidosis criteria (IWOS) and sarcoidosis-associated uveitis criteria (SUN) are defined. However, for children they are not yet established internationally. Due to the specificity of pediatric manifestations of sarcoidosis, this task is even more challenging. In children, sarcoidosis is subdivided into Blau syndrome and early-onset sarcoidosis (BS/EOS) affecting younger children (< 5 years) and the one affecting older children with clinical presentation resembling adults. Differential diagnosis, clinical work-up as well as diagnostic criteria should be adapted to each age group. In this article, we review the clinical manifestation of sarcoidosis-associated uveitis in adults and children and the sensitivity and specificity of various ocular sarcoidosis diagnostic modalities, including chest X-ray and CT, FDG PET-CT, gallium-67 scintigraphy, bronchoalveolar lavage fluid, genetic testing for NOD2 mutations and serum biomarkers, such as ACE, lysozyme and IL2R.

结节病相关葡萄膜炎是主要的眼部结节病表现,影响成人和儿童。对于成人,定义了国际眼部结节病标准(IWOS)和结节病相关葡萄膜炎标准(SUN)。然而,对于儿童来说,它们还没有在国际上建立起来。由于结节病儿童表现的特殊性,这项任务更具挑战性。在儿童中,结节病可细分为Blau综合征和影响幼儿的早发性结节病(BS/EOS)(
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引用次数: 0
Efficacy of intravitreal dexamethasone implant used as monotherapy for the treatment of macular edema in non-infectious uveitis: a retrospective analysis. 玻璃体内地塞米松植入物作为单一疗法治疗非感染性葡萄膜炎黄斑水肿的疗效:回顾性分析。
IF 2.9 Q2 Medicine Pub Date : 2023-09-18 DOI: 10.1186/s12348-023-00360-3
Rishi B Gupta, Julius Ilin, Chloe C Gottlieb

Background: Uveitic macular edema is a complication of acute or chronic uveitis. Current treatment regiments frequently have numerous side effects, often requiring supplemental treatment. This study investigates the efficacy of dexamethasone (DEX) intravitreal implants as monotherapy for treatment of macular edema in non-infectious intermediate, posterior or panuveitis.

Methods and results: Retrospective chart review of thirty patients with intermediate, posterior and panuveitis treated with DEX. Outcomes measured were central retinal thickness (CRT) and best corrected visual acuity (BCVA). Baseline measurements of CRT and BCVA were measured within 1 month prior to intravitreal DEX implant and follow up measurements were collected until 1 year post implant. 48 implants on 39 eyes of 30 patients were included in this study; 64.1% of patients had an improvement in BCVA and 65.4% had a reduction in CRT. BCVA improved from 0.285 logMAR (SD: 0.312) at baseline to 0.175 logMAR (SD: 0.194) at 1 month and was sustained thereafter. Preliminary CRT data showed a decrease from 392 [Formula: see text] (SD: [Formula: see text]) at baseline to 303 [Formula: see text] (SD: [Formula: see text] at 1 month and 313 [Formula: see text] (SD: [Formula: see text] at 12 months.

Conclusions: The DEX implant as monotherapy for macular edema in non-infectious uveitis was associated with a reduction in CRT and improvement in BCVA. The DEX implant, used as a monotherapy in eyes with intermediate, posterior and panuveitis, has the potential to treat uveitis without oral corticosteroid or other immunomodulatory therapy.

背景:葡萄膜炎性黄斑水肿是急性或慢性葡萄膜炎的并发症。目前的治疗方案经常有许多副作用,通常需要补充治疗。本研究探讨地塞米松(DEX)玻璃体内植入物作为单一疗法治疗非感染性中、后或全葡萄膜炎黄斑水肿的疗效。方法和结果:回顾性分析30例DEX治疗的中、后葡萄膜炎和全葡萄膜炎患者。测量的结果是视网膜中央厚度(CRT)和最佳矫正视力(BCVA)。在玻璃体内DEX植入前1个月内测量CRT和BCVA的基线测量值,并收集随访测量值,直到植入后1年。本研究包括30例患者39眼的48个植入物;64.1%的患者BCVA改善,65.4%的患者CRT降低。BCVA从基线时的0.285 logMAR(SD:0.312)改善到1个月时的0.175 logMAR(SD:0.194),并在此后持续。初步CRT数据显示,从基线时的392[公式:见正文](SD:[公式:见图正文])降至1个月时的303[公式:参见正文](SD:[公式:详见正文]12个月时。结论:DEX植入物作为非感染性葡萄膜炎黄斑水肿的单一疗法与CRT的减少和BCVA的改善有关。DEX植入物作为中间、后部和全葡萄膜炎眼的单一疗法,有可能在不使用口服皮质类固醇或其他免疫调节疗法的情况下治疗葡萄膜炎。
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引用次数: 0
Successful treatment of multidrug-resistant Pseudomonas aeruginosa keratitis with meropenem eye drops - a case report. 美罗培南滴眼液成功治疗耐多药铜绿假单胞菌角膜炎1例报告。
IF 2.9 Q2 Medicine Pub Date : 2023-09-16 DOI: 10.1186/s12348-023-00363-0
Carolin Elhardt, Armin Wolf, Christian Maximilian Wertheimer

Background: This case report describes the course and therapeutic management of a fast-spreading bacterial keratitis caused by multidrug-resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa).

Case presentation: A 27-year-old male contact lens wearer presented with a multi-resistant, fast spreading P. aeruginosa keratitis. After initial resistance to various antibiotic therapies, testing revealed a MDR P. aeruginosa. The keratitis was treated successfully with specially prepared 50 mg/ml off-label meropenem eye drops for 18 days as well as systemic meropenem for seven days with rapid improvement of the corneal infiltrate.

Conclusion: This case report demonstrates the combination of topical and systemic meropenem as a useful treatment option for corneal ulcers caused by MDR P. aeruginosa.

背景:本病例报告描述了由多重耐药(MDR)铜绿假单胞菌(P. aeruginosa)引起的快速传播的细菌性角膜炎的病程和治疗管理。病例介绍:一名27岁男性隐形眼镜佩戴者患有多重耐药、快速传播的铜绿假单胞菌性角膜炎。在最初对各种抗生素治疗产生耐药性后,检测发现了耐多药铜绿假单胞菌。经特殊配制的超说明书美罗培南滴眼液50 mg/ml治疗18天,并用全身美罗培南治疗7天,角膜浸润迅速改善。结论:本病例报告表明,局部和全身联合使用美罗培南是耐多药铜绿假单胞菌引起的角膜溃疡的有效治疗选择。
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引用次数: 0
Recurrent superior orbital fissure syndrome associated with VEXAS syndrome. 复发性眶上裂综合征与VEXAS综合征相关。
IF 2.9 Q2 Medicine Pub Date : 2023-09-07 DOI: 10.1186/s12348-023-00362-1
Katie Myint, Namritha Patrao, Oana Vonica, Kaveh Vahdani

Purpose: To describe a case of recurrent orbital inflammation and superior orbital fissure syndrome associated with VEXAS (vacuoles, E1 enzyme, X-linked, auto-inflammatory, somatic) syndrome.

Case presentation: VEXAS syndrome is a recently identified multi-system inflammatory disease of late adult onset. The authors describe the case of a 76-year-old man who presented with recurrent episodes of orbital inflammation, with superior orbital fissure syndrome, dacryoadenitis and orbital myositis. He had a constellation of systemic disorders including recurrent chest infections, congestive cardiac failure, pulmonary emboli and skin rashes. The underlying diagnosis of VEXAS syndrome was confirmed by genetic testing, which revealed the UBA1 mutation.

Conclusion: VEXAS syndrome should be considered in the differential diagnosis of orbital inflammatory disease associated with multi-system inflammatory disorders.

目的:报道一例复发性眶炎和眶上裂综合征合并VEXAS(空泡,E1酶,x连锁,自身炎症,躯体)综合征的病例。病例介绍:VEXAS综合征是最近发现的一种多系统炎症性疾病,发病晚于成人。作者描述了一个76岁的男子谁提出了反复发作的眶炎,眶上裂综合征,泪腺炎和眶肌炎。他有一系列全身性疾病,包括复发性胸部感染、充血性心力衰竭、肺栓塞和皮疹。通过基因检测证实了VEXAS综合征的潜在诊断,发现了UBA1突变。结论:眼眶炎性疾病合并多系统炎性疾病的鉴别诊断应考虑VEXAS综合征。
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引用次数: 0
Clinical characterization of patients with HLA-B27-associated uveitis and evaluation of the impact of systemic treatment on the recurrence rate: a cross-sectional study. hla - b27相关性葡萄膜炎患者的临床特征和评估全身治疗对复发率的影响:一项横断面研究
IF 2.9 Q2 Medicine Pub Date : 2023-08-30 DOI: 10.1186/s12348-023-00352-3
Juan Sebastián Pineda-Sierra, Carlos Cifuentes-González, William Rojas-Carabali, Paula Tatiana Muñoz-Vargas, Alejandro Henao-Posada, Alejandra de-la-Torre

Introduction: Despite HLA-B27-associated uveitis is one of the most frequent etiologies of uveitis worldwide, there are scarce studies on the clinical spectrum of this disease and the implications of therapeutic strategies used in the Latin-American population, with none conducted in Colombia. Thus, this study aimed to describe the clinical characteristics of a cohort of patients with positive HLA-B27-associated uveitis in Colombia and evaluate the impact of systemic treatment on the recurrence rate.

Methods: We retrospectively reviewed 490 clinical charts of patients with uveitis, searching for those with positive HLA-B27-associated uveitis over eight years in a referral center in Bogotá, Colombia. We used descriptive statistics to summarize demographic and clinical characteristics and conducted a Chi-square test, Fisher Exact test, Spearman correlation, and Mann-Whitney test to assess associations between treatment strategies and the recurrences rate.

Results: We analyzed 39 patients (59% females) with positive HLA-B27-associated uveitis, with a median age at the first consultation of 44.5 years (Range: 2-80) and a mean follow-up time of 86.4 weeks (1.65 years). Most patients had unilateral uveitis (53.8%) and an anterior anatomical diagnosis (76.6%); two had anterior chamber fibrinous reaction, and only one had hypopyon. Most patients did not show associated systemic symptoms (66.7%). Topical corticosteroids, NSAIDs, methotrexate, mydriatics, and adalimumab were the most used treatments. The most common complications included cataracts, posterior synechiae, and macular edema. We identified that the rate of recurrences decreases over time (r = -0.6361, P = 0.002571), and this decrease seems to be associated with the initiation of disease-modifying antirheumatic drugs (DMARDs) in chronic and recurrent cases.

Conclusion: The clinical spectrum of HLA-B27-associated uveitis in Colombian patients is distinct from other latitudes. Notably, we found a female predominance, older age at presentation, higher frequency of bilateral and vitreous involvement, and lower frequency of concomitant systemic diseases. Additionally, our results suggest that DMARDs such as methotrexate and biologic agents are good therapeutic options to avoid recurrences in chronic and recurrent cases.

导语:尽管hla - b27相关的葡萄膜炎是世界范围内葡萄膜炎最常见的病因之一,但关于这种疾病的临床谱和拉丁美洲人群中使用的治疗策略的影响的研究很少,在哥伦比亚没有进行过研究。因此,本研究旨在描述哥伦比亚一组hla - b27阳性相关性葡萄膜炎患者的临床特征,并评估全身治疗对复发率的影响。方法:我们回顾性地回顾了490例葡萄膜炎患者的临床图表,在哥伦比亚波哥大的一家转诊中心寻找8年来hla - b27相关葡萄膜炎阳性患者。我们使用描述性统计来总结人口学和临床特征,并进行卡方检验、Fisher精确检验、Spearman相关检验和Mann-Whitney检验来评估治疗策略与复发率之间的关系。结果:我们分析了39例hla - b27相关葡萄膜炎阳性患者(59%为女性),首次就诊时的中位年龄为44.5岁(范围:2-80岁),平均随访时间为86.4周(1.65年)。大多数患者为单侧葡萄膜炎(53.8%),前解剖诊断(76.6%);2例有前房纤维性反应,1例有垂体后叶。大多数患者未出现相关的全身症状(66.7%)。外用皮质类固醇、非甾体抗炎药、甲氨蝶呤、mydritics和阿达木单抗是最常用的治疗方法。最常见的并发症包括白内障、后粘连和黄斑水肿。我们发现复发率随着时间的推移而降低(r = -0.6361, P = 0.002571),这种降低似乎与慢性和复发病例开始使用改善疾病的抗风湿药物(DMARDs)有关。结论:哥伦比亚患者hla - b27相关性葡萄膜炎的临床谱不同于其他纬度地区。值得注意的是,我们发现女性居多,发病年龄较大,双侧和玻璃体受累的频率较高,而伴随全身性疾病的频率较低。此外,我们的研究结果表明,DMARDs如甲氨蝶呤和生物制剂是避免慢性和复发病例复发的良好治疗选择。
{"title":"Clinical characterization of patients with HLA-B27-associated uveitis and evaluation of the impact of systemic treatment on the recurrence rate: a cross-sectional study.","authors":"Juan Sebastián Pineda-Sierra, Carlos Cifuentes-González, William Rojas-Carabali, Paula Tatiana Muñoz-Vargas, Alejandro Henao-Posada, Alejandra de-la-Torre","doi":"10.1186/s12348-023-00352-3","DOIUrl":"10.1186/s12348-023-00352-3","url":null,"abstract":"<p><strong>Introduction: </strong>Despite HLA-B27-associated uveitis is one of the most frequent etiologies of uveitis worldwide, there are scarce studies on the clinical spectrum of this disease and the implications of therapeutic strategies used in the Latin-American population, with none conducted in Colombia. Thus, this study aimed to describe the clinical characteristics of a cohort of patients with positive HLA-B27-associated uveitis in Colombia and evaluate the impact of systemic treatment on the recurrence rate.</p><p><strong>Methods: </strong>We retrospectively reviewed 490 clinical charts of patients with uveitis, searching for those with positive HLA-B27-associated uveitis over eight years in a referral center in Bogotá, Colombia. We used descriptive statistics to summarize demographic and clinical characteristics and conducted a Chi-square test, Fisher Exact test, Spearman correlation, and Mann-Whitney test to assess associations between treatment strategies and the recurrences rate.</p><p><strong>Results: </strong>We analyzed 39 patients (59% females) with positive HLA-B27-associated uveitis, with a median age at the first consultation of 44.5 years (Range: 2-80) and a mean follow-up time of 86.4 weeks (1.65 years). Most patients had unilateral uveitis (53.8%) and an anterior anatomical diagnosis (76.6%); two had anterior chamber fibrinous reaction, and only one had hypopyon. Most patients did not show associated systemic symptoms (66.7%). Topical corticosteroids, NSAIDs, methotrexate, mydriatics, and adalimumab were the most used treatments. The most common complications included cataracts, posterior synechiae, and macular edema. We identified that the rate of recurrences decreases over time (r = -0.6361, P = 0.002571), and this decrease seems to be associated with the initiation of disease-modifying antirheumatic drugs (DMARDs) in chronic and recurrent cases.</p><p><strong>Conclusion: </strong>The clinical spectrum of HLA-B27-associated uveitis in Colombian patients is distinct from other latitudes. Notably, we found a female predominance, older age at presentation, higher frequency of bilateral and vitreous involvement, and lower frequency of concomitant systemic diseases. Additionally, our results suggest that DMARDs such as methotrexate and biologic agents are good therapeutic options to avoid recurrences in chronic and recurrent cases.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10468442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10134141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Targeting macrophage migration inhibitory factor (MIF): a promising therapy for inflammatory ocular diseases. 靶向巨噬细胞迁移抑制因子(MIF):一种治疗炎性眼病的新方法。
IF 2.9 Q2 Medicine Pub Date : 2023-08-25 DOI: 10.1186/s12348-023-00361-2
Alicia Vázquez, Marisol I González, José L Reyes

Inflammatory ocular diseases are characterized by the presence of a persistent inflammatory response which cause tissue injury, decrease visual acuity and in severe cases, blindness. Several cytokines represent a therapeutic opportunity since they are key amplifiers of these pathologies, and thus neutralizing agents against them have been developed. Amongst others, macrophage migration inhibitory factor (MIF), an early produced inflammatory cytokine, has consistently been found elevated in patients with distinct ocular diseases (inflammatory and autoimmune). Here, we present and discuss evidence showing that preclinical trials using diverse strategies to neutralize MIF resulted in significant attenuation of disease signs and therefore MIF blockage might be a promising therapy for ocular diseases.

炎症性眼部疾病的特点是存在持续的炎症反应,导致组织损伤,视力下降,严重时导致失明。一些细胞因子代表了治疗的机会,因为它们是这些病理的关键放大器,因此针对它们的中和剂已经开发出来。其中,巨噬细胞迁移抑制因子(MIF)是一种早期产生的炎症细胞因子,在患有不同眼部疾病(炎症性和自身免疫性)的患者中一直被发现升高。在这里,我们提出并讨论了证据,表明临床前试验使用不同的策略来中和MIF导致疾病症状的显著衰减,因此MIF阻断可能是一种有希望的眼部疾病治疗方法。
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引用次数: 0
Lightning can strike twice: recurrent multiple evanescent white dot syndrome (MEWDS) following both COVID-19 vaccination and subsequent COVID-19 infection. 闪电可击中两次:在COVID-19疫苗接种和随后的COVID-19感染后复发性多发性消失性白点综合征(MEWDS)。
IF 2.9 Q2 Medicine Pub Date : 2023-08-24 DOI: 10.1186/s12348-023-00355-0
Hannah W Ng, Rachael L Niederer

Multiple evanescent white dot syndrome has been reported to occur following COVID-19 vaccination and also secondary to COVID-19 infection. Increasingly, patients are querying their risk from further vaccination against COVID-19, vaccination for other diseases (such as influenza) and the risk of disease with COVID-19 infection itself. Here we report an interesting case in which the patient developed MEWDS following COVID vaccination, then, one year later, developed MEWDS in the fellow eye associated with COVID-19 infection.

据报道,在COVID-19疫苗接种后发生多次消失的白点综合征,也继发于COVID-19感染。越来越多的患者询问进一步接种COVID-19疫苗的风险、其他疾病(如流感)疫苗的风险以及感染COVID-19的疾病本身的风险。在这里,我们报告了一个有趣的病例,患者在接种COVID疫苗后出现了MEWDS,一年后,与COVID感染相关的另一只眼睛出现了MEWDS。
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引用次数: 0
Challenges in posterior uveitis-tips and tricks for the retina specialist. 后葡萄膜炎的挑战——视网膜专家的提示和技巧。
IF 2.9 Q2 Medicine Pub Date : 2023-08-17 DOI: 10.1186/s12348-023-00342-5
Manuel Paez-Escamilla, Sonny Caplash, Gagan Kalra, Jamie Odden, Danielle Price, Oscar C Marroquin, Stephen Koscumb, Patrick Commiskey, Chad Indermill, Jerome Finkelstein, Anna G Gushchin, Andreea Coca, Thomas R Friberg, Andrew W Eller, Denise S Gallagher, Jean C Harwick, Evan L Waxman, Jay Chhablani, Gabrielle Bonhomme, Colin Prensky, Alexander J Anetakis, Joseph N Martel, Erika Massicotte, Raphaelle Ores, Jean-Francois Girmens, Thomas M Pearce, Jose-Alain Sahel, Kunal Dansingani, Mark Westcott, Marie-Helene Errera

Purpose: Posterior uveitis is a common chorioretinal pathology affecting all ages worldwide and is a frequent reason for referral to the retina clinic. The spectrum of etiologies for uveitis is very broad and includes infectious and auto-immune diseases. Inflammation can be confined to the eye or may be a part of systemic disease. A useful outline is therefore proposed to aid in the correct diagnosis of these challenging entities. The situation is further complicated by the fact that many neoplastic conditions resemble features of posterior uveitis; they are known as "masqueraders of uveitis". Here, we summarize different posterior uveitides that present with rare findings, along with masqueraders that can be difficult to distinguish. These conditions pose a diagnostic dilemma resulting in delay in treatment because of diagnostic uncertainty.

Methods: An extensive literature search was performed on the MEDLINE/PUBMED, EBSCO and Cochrane CENTRAL databases from January 1985 to January 2022 for original studies and reviews of predetermined diagnoses that include posterior uveitic entities, panuveitis and masquerade syndromes.

Results: We described conditions that can present as mimickers of posterior uveitis (i.e., immune check-points inhibitors and Vogt-Koyanagi-Harada-like uveitis; leukemia and lymphoma associated posterior uveitis), inflammatory conditions that present as mimickers of retinal diseases (i.e., Purtscher-like retinopathy as a presentation of systemic lupus erythematosus; central serous chorioretinopathy masquerading inflammatory exudative retinal detachment), and uveitic conditions with rare and diagnostically challenging etiologies (i.e., paradoxical inflammatory effects of anti-TNF-α; post vaccination uveitis; ocular inflammation after intravitreal injection of antiangiogenic drugs).

Conclusion: This review of unique posterior uveitis cases highlights the overlapping features of posterior uveitis (paradoxical inflammatory effects of anti -TNF α and uveitis; Purtscher-like retinopathy as a presentation of systemic lupus erythematosus, …) and the nature of retinal conditions (ischemic ocular syndrome, or central retinal vein occlusion, amyloidosis, inherited conditions like retinitis pigmentosa, autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), etc.…) that may mimic them is represented. Careful review of past uveitis history, current medications and recent vaccinations, detailed examination of signs of past or present inflammation, eventually genetic testing and/ or multimodal retinal imaging (like fluorescein angiography, EDI-OCT, OCT-angiography for lupus Purtscher-like retinopathy evaluation, or ICG for central serous retinopathy, or retinal amyloid angiopathy) may aid in correct diagnosis.

目的:后葡萄膜炎是一种常见的视网膜病理影响所有年龄的世界范围内,是一个常见的原因转介到视网膜诊所。葡萄膜炎的病因非常广泛,包括感染性疾病和自身免疫性疾病。炎症可以局限于眼睛,也可能是全身性疾病的一部分。因此,提出了一个有用的大纲,以帮助正确诊断这些具有挑战性的实体。由于许多肿瘤类似后葡萄膜炎的特征,情况进一步复杂化;他们被称为“葡萄膜炎的假面舞者”。在这里,我们总结了罕见的后葡萄膜炎,以及难以区分的假面病。这些情况造成诊断困境,导致延误治疗,因为诊断的不确定性。方法:从1985年1月至2022年1月,在MEDLINE/PUBMED、EBSCO和Cochrane CENTRAL数据库中进行了广泛的文献检索,以获取原始研究和预先诊断的综述,包括后葡萄膜实体、全葡萄膜炎和假面综合征。结果:我们描述了可能表现为后葡萄膜炎模拟物的情况(即免疫检查点抑制剂和vogt - koyanagi - harada样葡萄膜炎;白血病和淋巴瘤相关的后葡萄膜炎),炎症状况表现为视网膜疾病的模拟物(即,purtscher样视网膜病变表现为系统性红斑狼疮;中心性浆液性脉络膜视网膜病变(伪装为炎症性渗出性视网膜脱离),以及罕见且具有诊断挑战性病因的葡萄膜病(即抗tnf -α的矛盾炎症作用;接种后葡萄膜炎;玻璃体内注射抗血管生成药物后的眼部炎症)。结论:本文回顾了独特的后葡萄膜炎病例,强调了后葡萄膜炎的重叠特征(抗tnf α和葡萄膜炎的矛盾炎症作用;purtscher样视网膜病变作为系统性红斑狼疮的表现,…)和视网膜疾病的性质(缺血性眼综合征,或视网膜中央静脉闭塞,淀粉样变性,遗传性疾病,如视网膜色素变性,常染色体显性新血管炎性玻璃体视网膜病变(ADNIV)等....)可能模拟它们。仔细回顾过去的葡萄膜炎病史,目前的药物治疗和最近的疫苗接种,详细检查过去或现在的炎症症状,最终进行基因检测和/或多模态视网膜成像(如荧光素血管造影,EDI-OCT, oct血管造影用于狼疮珀茨样视网膜病变评估,或ICG用于中枢浆液性视网膜病变,或视网膜淀粉样血管病)可能有助于正确诊断。
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引用次数: 0
Cytomegalovirus anterior uveitis and occlusive retinal vasculitis without retinitis in a patient on immunomodulatory therapy. 免疫调节治疗的巨细胞病毒前葡萄膜炎和视网膜闭塞性血管炎1例。
IF 2.9 Q2 Medicine Pub Date : 2023-08-04 DOI: 10.1186/s12348-023-00356-z
Lorenzo Fabozzi, Ilaria Testi, Laura De Benito-Llopis, Carlos Pavesio

Purpose: To describe unusual clinical features and therapeutic management of a case of cytomegalovirus (CMV) ocular disease in a patient on immunomodulatory therapy.

Setting/venue: Moorfields Eye Hospital NHS Foundation Trust, London, UK.

Methods: Medical history, clinical findings, investigation results, and multimodal imaging were retrospectively collected.

Results: A 61-year-old, South-East Asian man, developed CMV-related endotheliitis and occlusive retinal vasculitis, diagnosed by wide-angle fluorescein angiography. No retinitis was present on the fundus examination. Suspicion of CMV etiology was based on anterior segment findings, especially the presence of coin-shaped endothelial lesions. The diagnosis was confirmed by aqueous polymerase chain reaction (PCR) analysis which was positive for CMV DNA. The combined use of topical and systemic valganciclovir resulted in significant improvement of the picture.

Conclusions: CMV can manifest in the eye as occlusive retinal vasculitis without the presence of typical retinitis.

目的:描述一例巨细胞病毒(CMV)眼病患者接受免疫调节治疗的异常临床特征和治疗管理。地点/地点:英国伦敦Moorfields眼科医院NHS基金会信托基金。方法:回顾性收集患者的病史、临床表现、调查结果及多模态影像学资料。结果:一名61岁的东南亚男性,通过广角荧光素血管造影诊断为巨细胞病毒相关的内皮炎和闭塞性视网膜血管炎。眼底检查未见视网膜炎。怀疑巨细胞病毒的病因是基于前段的发现,特别是硬币状内皮病变的存在。经水相聚合酶链反应(PCR)分析证实,CMV DNA阳性。局部和全身联合使用缬更昔洛韦可显著改善图像。结论:巨细胞病毒可以在没有典型视网膜炎的情况下表现为视网膜闭塞性血管炎。
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Journal of Ophthalmic Inflammation and Infection
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