Ocular Manifestations of Sporotrichosis in a Hyperendemic Region in Brazil: Description of a Series of 120 Cases.

PURPOSE: To describe 120 cases of ocular sporotrichosis. METHODS: Review of medical records of patients with culture-proven (from eye specimen) ocular sporotrichosis, in Rio de Janeiro, from 2007 to 2017. RESULTS: Women were more affected (61.7%) and median age was 24 years. The isolated ocular form was more frequent (75.8%). Fixed cutaneous sporotrichosis was the most commonly associated form (48.3%). Hypersensitivity reactions were observed in 10% of patients. Ocular involvement was unilateral in 98.3% of the cases, and the most frequent clinical presentation was granulomatous conjunctivitis (86.7%), followed by eyelid lesion (25%). Dacryocystitis represented 7.5% of the cases, predominantly in children (55.6%). Itraconazole was the first choice treatment (95.8%). Sequelae were observed in 23 patients (22.5%), and surgical treatment was required for most of them. CONCLUSION: Ocular sporotrichosis can be considered a characteristic form of the zoonotic transmission, with high morbidity. Delay in initiating specific treatment is likely to increase the risk of progression to more severe forms of the disease, and development of ocular sequelae.

MULTIFOCAL CHOROIDITIS IN DISSEMINATED SPOROTRICHOSIS IN PATIENTS WITH HIV/AIDS.

PURPOSE: In this article, the authors describe multifocal choroiditis related to disseminated sporotrichosis in patients with HIV/AIDS. METHODS: We conducted a retrospective observational study of three patients infected with HIV who presented with disseminated sporotrichosis characterized by cutaneous lesions, multifocal choroiditis, and other manifestations, including osteomyelitis and involvement of the bone marrow, larynx, pharynx, and nasal and oral mucosa. RESULTS: Five eyes of three patients with HIV/AIDS showed multifocal choroiditis related to disseminated sporotrichosis. The CD4 counts ranged from 25 to 53 mm. All patients were asymptomatic visually. The ocular disease was bilateral in two patients. The lesion size ranged from 1/3 to 2 disc diameters. None of the patients had vitritis. Of the 12 lesions, 9 were localized in the posterior pole (Zone 1) and 3 were localized in the mild periphery (Zone 2). CONCLUSION: Multifocal choroiditis due to disseminated sporotrichosis can occur in profoundly immunosuppressed patients with HIV/AIDS.

Risk of reactivation of toxoplasmic retinitis following intraocular procedures without the use of prophylactic therapy.

BACKGROUND/AIMS: Toxoplasmic retinochoroiditis is the commonest known cause of posterior uveitis worldwide and reactivation is unpredictable. Based on results from one study, the authors proposed that antitoxoplasmic therapy should be initiated as prophylaxis for intraocular surgery in patients with toxoplasmic scars. The aim of this study is to analyse the risk of toxoplasmic retinochoroiditis reactivation following intraocular procedures. METHODS: Retrospective analysis of the medical records of a total of 69 patients who underwent intraocular surgery and presented with toxoplasmic retinochoroiditis scars. RESULTS: No patient received prophylactic antitoxoplasmic therapy. Reactivation following the surgical procedure occurred in four cases, with one at 3 months and the others respectively at 13, 14 and 17 months. CONCLUSIONS: Our study shows that intraocular surgery did not result in a significant reactivation rate of toxoplasmic retinochoroiditis in the absence of preoperative prophylactic antitoxoplasmic therapy.

Orbital parasitosis.

Orbital parasitoses are uncommon diseases. Due to specific characteristics of orbital space, many different diseases, such as tumors and inflammatory disease, can present with similar clinical manifestations. The aim of this study is to review the most important clinical, epidemiological, and treatment aspects of orbital parasitoses described worldwide.

Cat-scratch disease: ocular manifestations and visual outcome.

To describe the intra-ocular manifestations of cat-scratch disease (CSD) found at two uveitis reference centers in Brazil. Retrospective case series study. Review of clinical records of patients diagnosed with CSD in the Uveitis Department of São Geraldo Hospital and the Ophthalmology Department of the Instituto de Pesquisa Clínica Evandro Chagas-FIOCRUZ, from 2001 to 2008. In the 8-year period, 24 patients with the diagnosis of CSD were identified. Twelve patients were male and 12 female. The mean age was 27.04 years (range 7-56). Sixteen patients (66.6%) presented with a history of a cat scratch and all patients reported cat exposure. Visual acuity ranged from counting fingers to 1.0 in the affected eye. Thirteen patients presented with bilateral disease. Sixteen (66.6%) patients complained of systemic symptoms, including fever, lymphadenopathy, liver and spleen enlargement and rash. All patients presented with serum antibodies (IgG) to Bartonella henselae. Thirty-seven eyes were affected. The most common findings were small areas of retinal infiltrates which occurred in 11 eyes (29.7%) and angiomatous lesions which occurred in nine eyes (24.3%). Neuroretinitis occurred in only six eyes (16.2%). The most common findings of CSD in our study were retinal infiltrates and angiomatous lesions. CSD patients may present with significant visual loss. Patients may benefit from systemic treatment with antibiotics.

Multifocal choroiditis in disseminated Cryptococcus neoformans infection.

PURPOSE: To report an uncommon case of multifocal choroiditis as the result of disseminated Cryptococcus neoformans infection in a patient who is HIV-positive. DESIGN: Interventional case report. METHODS: A 27-year-old HIV-positive woman with fever, headache, and vomiting was examined. Lumbar puncture was performed and revealed C neoformans infection. Her condition evolved with sudden bilateral blindness and deafness. Ophthalmologic examination revealed multiple yellowish choroidal lesions in the posterior pole of both eyes. RESULTS: Postmortem examination showed disseminated C neoformans infection. Histologic examination of the eyes confirmed the presence of C neoformans in the choroiditis. CONCLUSION: Multifocal choroiditis in C neoformans infection is a rare ophthalmic manifestation. The recognition of this condition by ophthalmologists can help physicians to diagnose a disseminated and fatal disease.

Ocular manifestation of cat-scratch disease in HIV-positive patients.

PURPOSE: To characterize ocular manifestations of cat-scratch disease in HIV-positive patients. DESIGN: Retrospective case series study. METHODS: Records and photography of patients with the diagnosis of cat-scratch disease and HIV were reviewed. RESULTS: From 2001 and 2004 three patients with cat-scratch disease and HIV were identified. All patients presented with subretinal mass associated with an abnormal vascular network. Fluorescein angiography revealed this abnormal vascular network more clearly. All patients were treated with antibiotics alone with good response. CONCLUSIONS: Subretinal mass associated with abnormal vascular network is characteristic of cat-scratch disease in HIV-positive patients. Fluorescein angiography is important to characterize this vascular pattern, and patients may benefit from systemic treatment.

Fuchs' heterochromic cyclitis.

Fuchs' heterochromic cyclitis (FHC) is a chronic anterior segment inflammatory syndrome that accounts for 2 to 3% of all uveitis cases. The etiology is unknown, but Herpes simplex, ocular toxoplasmosis and rubella infection have been implicated in the pathogenesis of the disease. It occurs more commonly in the third and fourth decades of life with an equal gender distribution. Patients are usually asymptomatic but may present with floaters and blurry vision. There is a mild but persistent anterior chamber reaction with diffuse and characteristic white stellate keratic precipitates. Iris and trabecular meshwork show abnormal vessels that may sometimes lead to a hyphema. Synechia formation is uncommon. Heterochromia is considered an important feature and accounts for the name, but it is variable depending on the intensity of the anterior stromal atrophy, initial iris color and amount of pigment in the iris pigmented epithelium. Progression of the disease is associated with cataract formation and glaucoma. Anti-inflammatory treatment is not indicated for the low-grade anterior chamber reaction seen in Fuchs' patients. Occasionally, a short course of corticosteroids is indicated if a symptomatic exacerbation occurs. The long-term prognosis is good, and patients usually maintain a visual acuity of 20/40 or better.

Intermediate uveitis.

Intermediate uveitis is an intraocular inflammation involving the anterior vitreous, peripheral retina and pars plana. It usually affects patients from 5 to 30 years old, without gender or racial preferences. The etiology is unknown but there are several associated diseases: multiple sclerosis, idiopathic optic neuritis, autoimmune corneal endotheliopathy, sarcoidosis, thyroid diseases and inflammatory bowel diseases. Symptoms are blurry vision, floaters and distortion of central vision. The syndrome is bilateral in 80% of the patients and chronic with periods of exacerbation and remission. Clinical presentation includes: mild to moderate anterior chamber inflammation, thin keratic precipitates in the inferior portion of the cornea, autoimmune endotheliopathy, vitreitis, vasculitis in the peripheral retina, intravitreal "snowballs," retinal "snowbanking," optic neuritis and cystoid macular edema. Cataract and glaucoma are frequent complications. Treatment of intermediate uveitis is based on periocular and oral corticosteroids. Cryotherapy or laser photocoagulation of the peripheral retina are options in patients with snowbanking when there is an insufficient response to periocular or systemic corticosteroids. Imunosuppression may also be used when other therapies fail, and Cyclosporin A is the first drug of choice. Pars plana vitrectomy is indicated in patients with chronic significant inflammation, non-responsive cystoid macular edema, non-clearing vitreous hemorrhage, tractional retinal detachment and epiretinal membranes. The long-term prognosis of intermediate uveitis is usually good, particularly with strict control of inflammation and with proper management of complications. Patients can often maintain a vision of 20/50 or better.

Posterior scleritis in Cogan's syndrome.

PURPOSE: To describe an unusual case of atypical Cogan's syndrome with features of posterior scleritis. METHODS: Interventional case report. RESULTS: A 53-year-old man presented with bilateral posterior scleritis, along with sensorineural hearing loss and systemic vasculitis. Systemic corticosteroid therapy was started with resolution of ophthalmic findings and improvement of vestibuloauditory symptoms. CONCLUSIONS: In the setting of atypical Cogan's syndrome, ophthalmic manifestations may be the first sign of disease.

Retinal granuloma caused by Sporothrix schenckii.

PURPOSE: To describe an unusual case of disseminated sporotrichosis with intraocular involvement. DESIGN: Interventional case report. RESULTS: An 18-year-old man presented with disseminated ulcerated skin lesions. Fundus examination showed fluffy opacities in the vitreous and a retinal granuloma in the left eye. Biopsy of the skin lesion and lymph node showed the presence of numerous fungus cells. Culture was positive for the diagnosis of disseminated sporotrichosis. CONCLUSION: Although intraocular infection due to Sporothrix schenckii is uncommon, it can occur in case of disseminated sporotrichosis. Systemic therapy is a successful means to control skin and ocular sporotrichosis.

Retinopatia associada ao uso de didadosina / Retinopathy associated with the use of didanosine

Os autores descrevem um caso de paciente adulto infectado com o vírus da imunodeficiéncia humana (HIV) que apresentou retinopatia tóxica secundária ao uso da didanosina (DDI). A didanosina é inibidor da transcriptase reversa utilizado no tratamento da síndrome da imunodeficiência adquirida (AIDS).A associaçäo da didanosina com retinopatia é bem estabelecida em crianças, porém é bastante rara em adultos.

Evoluçäo da retinite por citomegalovirus após suspensäo de terapia de manutençäo em pacientes com recuperaçäo imunológica após HAART / Cytomegalovirus retinitis outcome following maintenance therapy discontinuation in patients with immune recovery due to HAART

Objetivo: Estabelecer critérios seguros para a suspensäo da terapia de manutençäo anti-CMV em pacientes que apresentaram recuperaçäo imunológica após o uso da HAART ("Highly Active Antiretroviral therapy"). Métodos: Vinte e quatro pacientes que apresentavam retinite por citomegalovirus inativa, carga viral indetectável e contagem de CD4+>200 cél./mm3 tiveram a medicaçäo anti CMV de manutençäo suspensa. Os pacientes mantiveram acompanhamento quinzenal por meio de oftalmoscopia indireta a partir da suspensäo da terapia até dezembro de 1998. Resultados: Dos 24 pacientes estudados nenhum apresentou reativaçäo ou progressäo da retinite. Todos os pacientes mantiveram a contagem de CD4+>200 cél./mm3. Apenas um apresentou carga viral de 4000 cópias, os demais mantiveram carga viral indetectável. O acompanhamento médio dos pacientes foi de 10,5 meses. Conclusäo: Acreditamos que os parâmetros por nós estabelecidos sejam seguros para a suspensäo da terapia de manutençäo, porém novos estudos devam ser realizados a fim de estabelecer outros critérios. O exame oftalmológico, a contagem de CD4+ e a carga viral säo fundamentais no acompanhamento dos pacientes após a suspensäo da terapia específica de manutençäo para a retinite por CMV.

Necrose retiniana aguda na Síndrome da Imunodeficiência Adquirida: prognóstico visual / Immunodeficiency Syndrome: visual outcome

Objetivo: Avaliar a acuidade visual após o tratamento em pacientes com diagnóstico de necrose retiniana aguda. Métodos: Realizou-se estudo retrospectivo de 40 pacientes HIV positivos e com diagnóstico clínico de necrose retiniana aguda, os quais foram submetidos a exame oftalmológico completo e tratados com terapia anti-viral (Acyclovir e Ganciclovir). Vitrectomia via pars plana com óleo de silicone e endolaser foi realizada quando necessária. Os casos foram divididos em três grupos, de acordo com acuidade visual final. Resultado: Do total de 80 olhos estudadps (40 pacientes), 52 olhos (65 por cento) apresentaram necrose retiniana aguda. Nenhum olho apresentou acuidade visual melhor que 20/40. Somente 7 (13,5 por cento) olhos encontravam-se entre 20/50 e 20/200. Os demais 45 olhos (86,5 por cento) apresentaram acuidade visual pior que 20/200, sendo que 21 (40,3 por cento) evoluíram com phytisis bulbi.

Vasculite retiniana hemorragica multifocal aguda (Blumenkranz) / Acute multifocal hemorrhagic retinal vasculitis

Os autores descrevem 2 casos (4 olhos) com vasculite retiniana com características compatíveis com uma forma especial de vasculite idiopatia denominada vasculite retiniana heomorrágica multifocal aguda. Discutem a fisiopatia como também o exame de PCR (reaçäo em cadeia da polimerase) realizado em um caso.

Estudo epidemiológico das alteraçöes oftalmológicas na Síndrome da Imunodeficiência Adquirida / Ophthalmologic changes in the Acquired Immunodeficiency Syndrome - an epidemiologic study

Foram estudados 1986 pacientes HIV+ no período de abril de 1994 a dezembro de 1997. Foram encontrados 700 pacientes com alteraçöes oftalmológicas, sendo a retinite por citomegalovírus o achado mais frequente (13,19 por cento). Outros achados foram: microangiopatia pelo HIV, retinocoroidite toxoplásmica, retinite herpética, nódulos por BK e alteraçöes secundárias ao ryptococcus neofarmans e ao Treponema pallidum. Casos mais raros foram: endoftalmite por Candida, Sarcoma de Kaposi e Linfoma. O Objetivo deste trabalho é apresentar um estudo epidemiológico das alteraçöes oftalmológicas da AIDS em nosso meio

Coroidite criptocócica em síndrome de imunodeficiência adquirida / Crytococal choroiditis in acquired immunodeficiency syndrome

Objetivo: Decrever coroidite criptocócica em pacientes com Síndrome de Imunodeficiência Adquirida (AIDS).Métodos: Estudo retrospectivo de 1986 pacientes infectados pelo Vírus da Imunodeficiência humana (HIV), no período de abril de 1994 a dezembro de 1997, sendo 31 1,56 (por cento) com meningite criptocócica e manifestaçöes oculares. Destes, 4 pacientes com coroidite criptocócica e manifestaçöes oculares. Destes, 4 pacientes om coroidite criptocócica foram submetidos a exame oftalmológico, retinografia e angiofluoresceinografia. Resultados: A coroidite multifocal com 4 casos representou 12,9 (por cento) dos casos de criptococose ocular e 0,2 dos pacientes HIV positivos exsminados no período do estudo. Os 4 pacientes tiveram acometimento ocular bilateral, eram do sexo masculino com idade média de 29,75 anos e CD4 médio de 71,25 células/mm3. a acuidade visual em 7 olhos foi de 20/20 e em um olho de 20/100. Conclusäo: A corodite criptocócia é um acometimento raro em pacientes HIV positivos. O comprometimento coroidiano pelo Cryptococcus neoformans näo é indicativo de pior prognóstico da meningite criptocócica em pacientes com AIDS

Sídrome de parinaud em paciente com AIDS-Apresentaçäo de caso / Parinaud's syndrme in a AIDS patient-case report

As alteraçöes neuro-oftalmologicas em pacientes HIV positivo säo achados infreqüêntes. As principais alteraçöes säo: papiledema, neuropatia óptica e distúrbios da motilidade. O objetivo do nosso trabalho é apresentar um caso em que o paciente apresentava retraçäo palpebral associada à paralisia de movimentos verticais conjugados. Fizemos o diagnóstico de Síndrome de Parinaud, o que ainda näo foi descrito em nosso meio em associaçäo à Síndrome da imunodeficiência Adquirida