RESUMO
CLINICAL CASE: We report four patients with both decreased visual acuity and retinochoroidal lesions compatible with ocular toxoplasmosis in which a diagnosis of active toxoplasmic retinochoroiditis or choroidal neovascular membrane was made based on a specifically designed diagnostic screening. DISCUSSION: In the context of a compatible clinical picture, with retinochoroidal scars and low grade or absence of inflammation, choroidal neovascular membranes may mimic active toxoplasmic retinochoroiditis and vice-versa. A thorough ophthalmic, serological, and immunological examination (in ocular fluids) may help in the differential diagnosis allowing for proper therapeutic decision-making.
Assuntos
Anticorpos Antiprotozoários/sangue , Coriorretinite/diagnóstico , Neovascularização de Coroide/diagnóstico , Toxoplasma/imunologia , Toxoplasmose Ocular/diagnóstico , Adulto , Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Bevacizumab , Coriorretinite/sangue , Coriorretinite/complicações , Coriorretinite/tratamento farmacológico , Coriorretinite/patologia , Neovascularização de Coroide/sangue , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/etiologia , Cicatriz/etiologia , Cicatriz/patologia , Coccidiostáticos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Macula Lutea/patologia , Edema Macular/etiologia , Masculino , Recidiva , Toxoplasmose Ocular/sangue , Toxoplasmose Ocular/complicações , Toxoplasmose Ocular/tratamento farmacológico , Toxoplasmose Ocular/patologia , Acuidade Visual , Adulto JovemRESUMO
CLINICAL CASE: We report the case of a 74-year-old female who developed a necrotizing sclerokeratitis affecting her left eye after uncomplicated cataract surgery. She had no previous history of systemic autoimmune disease. Histopathology of the lesion revealed necrotic granulomatosis with an increased number of plasma cells. DISCUSSION: Surgically induced necrotizing sclerokeratitis (SINS) is a serious entity which requires prompt and aggressive therapy to prevent its potential devastating ocular consequences. Conjunctival resection and amniotic membrane grafting may be necessary to temporarily interrupt local immunologic events in severe cases. However, associated systemic immunomodulatory therapy seems to be mandatory (Arch Soc Esp Oftalmol 2009; 84: 577-580).
Assuntos
Âmnio/transplante , Imunossupressores/uso terapêutico , Ceratite/terapia , Complicações Pós-Operatórias/terapia , Doenças da Esclera/terapia , Idoso , Terapia Combinada , Feminino , Humanos , Ceratite/etiologia , Ceratite/patologia , Necrose , Complicações Pós-Operatórias/etiologia , Indução de Remissão , Doenças da Esclera/etiologia , Doenças da Esclera/patologiaRESUMO
CASE REPORT: The case of a 64-year-old patient with bilateral, progressive and painless diminution of visual acuity is presented. Ophthalmologic evaluation revealed optic neuritis and vitreous cells in both eyes, at different stages. Suspecting a paraneoplastic optic neuritis, the study of antibodies was requested. This showed positivity to the marker CRMP-5-IgG. After mediastinoscopy, a small cell lung carcinoma was diagnosed. DISCUSSION: Autoantibody CRMP-5-IgG defines a paraneoplastic entity of combined optic neuritis and vitreous inflammatory cells. The serological positivity avoids the vitreous biopsy and expedites the search for cancer. In our case, it allowed the diagnosis a previously unidentified tumor.