RESUMO
A 51 year-old man with hairy cell leukaemia was treated with pentostatin. While receiving the treatment, he was diagnosed with herpes retinitis in his right eye. After the last cycle of pentostatin the patient developed a mild vitritis and cystoid macular oedema. There were no signs of herpes retinitis reactivation. After excluding other possible causes of intraocular inflammation, a diagnosis of immune recovery uveitis was made. The patient was treated with 2-monthly retro-septal injections of triamcinolone, oral corticosteroids, intravitreal dexamethasone implants and, finally, pars plana vitrectomy. An immune recovery uveitis-like response is possible in HIV negative individuals. The immune reconstitution after the treatment of hairy cell leukaemia may have led to intraocular inflammation. Management of immune recovery uveitis is challenging and difficult. Pars plana vitrectomy may be necessary. Ophthalmologists should be alert to the possibility of immune recovery uveitis in HIV negative patients.
Assuntos
Infecções por Herpesviridae , Síndrome Inflamatória da Reconstituição Imune/imunologia , Leucemia de Células Pilosas/complicações , Retinite/virologia , Uveíte/imunologia , Antineoplásicos/uso terapêutico , Humanos , Síndrome Inflamatória da Reconstituição Imune/diagnóstico , Leucemia de Células Pilosas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pentostatina/uso terapêutico , Uveíte/diagnóstico , Acuidade VisualRESUMO
A 32 year-old man who presented with severe elevation of blood pressure after failure of kidney transplant. The patient had multiple serous retinal detachments, venous dilation, arteriolar narrowing, retinal haemorrhages, as well as optic disc oedema. Due to the impossibility of performing a fluorescein angiography, an angiotomography and en-face optical coherence tomography images were used to identify the vascular alterations in the retina, choroid, and choriocapillaris. Angiotomography and en face-optical coherence tomography mode images are very useful in cases where it is not possible to perform fluorescein angiography.
Assuntos
Hipertensão Maligna/complicações , Transplante de Rim/efeitos adversos , Adulto , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Corioide/irrigação sanguínea , Corioide/diagnóstico por imagem , Humanos , Rim/lesões , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Insuficiência Renal/cirurgia , Descolamento Retiniano/diagnóstico por imagem , Descolamento Retiniano/etiologia , Hemorragia Retiniana/diagnóstico por imagem , Hemorragia Retiniana/etiologia , Oclusão da Veia Retiniana/diagnóstico por imagem , Oclusão da Veia Retiniana/etiologia , Tomografia de Coerência Óptica , Falha de TratamentoRESUMO
A 30 year-old man with acute myeloblastic leukaemia and secondary myelodysplastic syndrome developed graft-versus-host disease. The patient was treated with ruxolitinib. After being treated for 3 months with ruxolitinib, an inhibitor of Janus kinase, he developed Aspergillus retinal necrosis resistant to common treatment. Treatment with Janus kinase inhibitors may lead to an increased incidence of opportunistic infections. Janus kinase inhibitor administration may result in poor treatment efficacy.
Assuntos
Aspergilose/complicações , Infecções Oculares Fúngicas/microbiologia , Pirazóis/efeitos adversos , Retina/patologia , Adulto , Aspergilose/tratamento farmacológico , Aspergillus flavus/isolamento & purificação , Aspergillus niger/isolamento & purificação , Evolução Fatal , Doença Enxerto-Hospedeiro/tratamento farmacológico , Humanos , Isquemia/diagnóstico por imagem , Leucemia Mieloide Aguda/tratamento farmacológico , Masculino , Síndromes Mielodisplásicas/etiologia , Necrose/microbiologia , Nitrilas , Infecções Oportunistas/microbiologia , Pirimidinas , Vasos Retinianos/diagnóstico por imagemRESUMO
CASE REPORT: The case is presented of a 39-year-old woman with metastatic melanoma treated with dabrafenib and trametinib. She presented with a severe acute panuveitis with granulomatous anterior uveitis, vitritis, and multiple serous retinal detachments. Dabrafenib and trametinib were suspended, and treatment with a systemic and topical corticosteroid was started. A good response was obtained, with a recovery of visual acuity of 1.0 in both eyes within two weeks. DISCUSSION: Dabrafenib and trametinib can lead to severe uveitis. Treatment with corticosteroids and discontinuation of therapy with dabrafenib and trametinib led to an anatomical and functional improvement, and resolved the episode rapidly. Ophthalmologists must be aware of this toxicity, given the increasing use of those drugs.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Imidazóis/efeitos adversos , Oximas/efeitos adversos , Pan-Uveíte/induzido quimicamente , Piridonas/efeitos adversos , Pirimidinonas/efeitos adversos , Descolamento Retiniano/induzido quimicamente , Corticosteroides/uso terapêutico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Azetidinas/administração & dosagem , Azetidinas/efeitos adversos , Sinergismo Farmacológico , Evolução Fatal , Feminino , Humanos , Imidazóis/administração & dosagem , MAP Quinase Quinase Quinases/antagonistas & inibidores , Melanoma/tratamento farmacológico , Melanoma/secundário , Proteínas de Neoplasias/antagonistas & inibidores , Oximas/administração & dosagem , Pan-Uveíte/tratamento farmacológico , Piperidinas/administração & dosagem , Piperidinas/efeitos adversos , Proteínas Proto-Oncogênicas B-raf/antagonistas & inibidores , Piridonas/administração & dosagem , Pirimidinonas/administração & dosagem , Vemurafenib/administração & dosagemRESUMO
CASE REPORT: The case is presented of a 42 year-old man with episodes of unilateral uveitis in his right eye. Ophthalmic examination showed a granulomatous anterior uveitis with vitritis. Systemic investigations revealed non-nephrotic proteinuria and microhaematuria. A renal biopsy showed IgA nephropathy. DISCUSSION: Uveitis and glomerulonephritis may have common immunological pathogenesis. IgA nephropathy should be a differential diagnosis in patients with uveitis and nephropathy.