Longitudinal analysis of serum cytokine profile among patients with tubercular multifocal serpiginoid choroiditis: a pilot study.

PURPOSE: To analyze the serum cytokines profile in patients with tubercular multifocal serpiginoid choroiditis (TB MSC) receiving anti-tubercular therapy (ATT) and oral corticosteroids. METHODS: In this prospective longitudinal study, patients with active TB MSC were included. Serum levels of interferon (IFN)-γ, interleukin (IL)-10, and tumor necrosis factor (TNF)-α were analyzed using bead-based immunoassay. The levels of transforming growth factor (TGF)-ß were measured using cytokine bead array. Serial measurement was performed at baseline, 1, 3, and 6 weeks after initiation of therapy. Patients developing paradoxical worsening (PW) of TB MSC were identified and their serum levels of cytokines were compared with those patients who showed healing of lesions. Comparison of cytokine levels with baseline values was also performed. RESULTS: Twelve patients (three females) were included in the study. Four patients showed paradoxical worsening of TB MSC at 3.2 ± 1 weeks after initiation of therapy. Compared to patients who showed healing of lesions, patients with PW showed higher baseline IL-10 (not significant; p = 0.28). Among patients developing PW, levels of IFN-γ peaked at 1 week ((p = 0.01) and levels of TNF-α peaked at 3 weeks (p = 0.02) (coinciding with PW) compared to patients who showed healing. There was no significant difference in TGF-ß levels at any time point in either group (p > 0.47). CONCLUSIONS: Baseline and serial levels of inflammatory serum cytokines may help in predicting the response to ATT and corticosteroids in TB MSC. Patients with paradoxical worsening may show rise in pro-inflammatory cytokines after initiation of ATT indicating higher bacillary load.

Case of cryptococcal choroiditis in adult with T-cell leukemia/lymphoma.

A rare case of 70-year-old woman with adult T-cell leukemia/lymphoma who developed multifocal choroiditis from a dissemination of Cryptococcus neoformans is reported. Ophthalmologic examination revealed multiple yellowish choroidal lesions in the posterior pole of both eyes. Sequential optical coherence tomographic images disclosed the involvement of the choroid and the consecutive changes in its architecture during the course of treatment. The recognition of these ocular manifestations may be important for the rapid diagnosis of C. nerformans-disseminated diseases. Rapid diagnosis and prompt therapy with intravitreal injection as well as systemic fosfluconazole and liposomal amphotericin B led to clinical improvement of intraocular cryptococcosis.

[Hemostasis in patients with diseases of the retina and uveal tract]. / Sostoianie gemostaza u bol'nykh s patologiei setchatki i sosudistogo trakta glaza.

Hemostasis studies of 152 patients with inflammatory dystrophic and circulatory diseases of the retina and the uveal tract have shown that the major hemostasis disorders consisted in the presence of soluble fibrin monomer complexes in the blood of 62-90.5% of patients and in retarded lysis of the blood euglobulin fraction. Patients with the above hemostasis disorders and central serous chorioretinopathies and abiotrophies develop delayed formation of the fibrin clot and its poor retraction, that is characteristic of latent imbalance of the coagulation and fibrinolysis processes and liability to DIC. Patients with retinal vein thrombosis develop, besides delayed fibrin polymerization in the clot and reduction of platelet contractility, a drastic depression of the blood and lacrimal fibrinolytic activity. Central choroiditis and uveitis was associated with a marked increase of lacrimal fibrinolysis and reduced blood plasma fibrinolysis, along with enhanced paracoagulation and prolonged lysis of the blood euglobulin fraction, this resulting in hypoproteolytic hypercoagulation. Local and systemic fibrinolysis test may help choose the drugs for local and general pathogenetic therapy.

The possible role of herpes viruses in multifocal choroiditis and panuveitis.

7 cases of multifocal choroiditis and panuveitis are reported here (6 females, 1 male). All clinical data were carefully considered. In all cases an aqueous sampling was made for the detection of anti-herpes virus antibodies in aqueous and serum. 3 specificities were tested: herpes simplex (HSV), herpes zoster (HVZ) and cytomegalovirus (CMV). An intraocular synthesis of specific antibodies was found against VZV in 2 cases and against HSV in 1 case. There was another presumptive case for HSV.

Elevation of von Willebrand factor is independent of erythrocyte sedimentation rate and persists after glucocorticoid treatment in giant cell arteritis.

Von Willebrand factor (vWF) antigen levels were measured in 39 patients with biopsy-proven giant cell arteritis (GCA), 16 patients with polymyalgia rheumatica (PMR), 12 patients with Sjögren's syndrome, and 7 with choroiditis, as well as in 20 age- and sex-matched controls. Among GCA patients, 31 (group A) had clinically inactive disease and were taking low-dose glucocorticoids for at least 1 year; their vWF levels were high even in the presence of a normalized erythrocyte sedimentation rate (ESR). When the ESR and vWF were analyzed in another 8 GCA patients (group B) before and after treatment with glucocorticoids, vWF remained elevated even though the ESR returned to normal. Among the highest levels of vWF were those of 3 GCA patients who presented with ocular symptoms and positive temporal artery biopsies, but normal ESR. The presence of elevated vWF was not specific for GCA since elevated levels were also found in patients with PMR, Sjögren's syndrome, and choroiditis. The levels of vWF in GCA were significantly higher (P less than 0.01) than in these other conditions associated with myalgias and eye symptoms. Elevation of vWF levels may help in the differential diagnosis of GCA, particularly when the ESR is normal and ocular symptoms are present.