ABSTRACT
PURPOSE: To report a case of Mycobacterium hemophilum of the eye. METHODS: Case report with pathologic correlation. A 55-year-old Malaysian man with a 3-year history of graft-versus-host disease presented with dry eye and keratopathy. RESULTS: The diagnosis was not initially evident, despite biopsy specimens of the conjunctiva. Definitive diagnosis was made after dermatology consultation suggested a histoid variant of lepromatous leprosy, prompting Ziehl-Neelsen staining of the initial and subsequent conjunctival biopsies with subsequent polymerase chain reaction testing. Anti-M. hemophilum treatment resulted in prompt resolution of ocular signs. CONCLUSIONS: Mycobacterium hemophilum is a rare condition, affecting mainly immunocompromised patients. Although filamentary keratopathy has been described as common manifestations of leprosy, to date, no ocular manifestations of M. hemophilum have been described. Conjoint management with infectious disease and clinical microbiology is imperative to ensure accurate diagnosis and appropriate early intervention. The effect of systemic immunosuppression is relevant in such patients.
Subject(s)
Conjunctival Diseases/microbiology , Corneal Diseases/microbiology , Eye Infections, Bacterial/microbiology , Immunocompromised Host , Mycobacterium Infections/microbiology , Mycobacterium haemophilum/isolation & purification , Conjunctival Diseases/diagnosis , Conjunctival Diseases/drug therapy , Corneal Diseases/diagnosis , Corneal Diseases/drug therapy , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/drug therapy , Graft vs Host Disease/drug therapy , Graft vs Host Disease/immunology , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Mycobacterium Infections/diagnosis , Mycobacterium Infections/drug therapySubject(s)
Corneal Diseases/diagnosis , Eye Infections, Bacterial/diagnosis , Leprosy, Lepromatous/diagnosis , Aged , Corneal Diseases/drug therapy , Corneal Diseases/microbiology , Dapsone/therapeutic use , Drug Therapy, Combination , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/microbiology , Female , Humans , Leprostatic Agents/therapeutic use , Leprosy, Lepromatous/drug therapy , Leprosy, Lepromatous/microbiology , Rifampin/therapeutic useABSTRACT
It is well known that ocular changes occur in leprosy, but data on their frequency differ very considerably (0.8-100%). Two groups of lepers in Togo were examined: first, 206 lepers who had had the disease for approximately 10 years and a second group (101) patients who had been suffering from it for approximately 24 years and had severe mutilations. It became apparent that sooner or later all lepers suffer from ocular complications. The following symptoms were found: loss of the eyebrows in 40.8% (42.6%), loss of the eyelashes in 29.6% (34.6%), lagophthalmos caused by involvement of the 7th cranial nerve in 21.4% (31.7%), corneal changes in 34.5% (49.5%), uveitis in 5.8% (19.8%), atrophy of the optic nerve in 12.6% (11.9%) and cataract in 21.8% (12.8%). The duration of the disease, the type of leprosy and the time when treatment was started are obviously the main factors associated with ocular changes in leprosy.
Subject(s)
Eye Diseases/diagnosis , Leprosy/diagnosis , Adult , Blindness/diagnosis , Corneal Diseases/diagnosis , Eyelid Diseases/diagnosis , Facial Paralysis/diagnosis , Female , Humans , Male , Middle Aged , Optic Atrophy/diagnosis , Sclera , TogoABSTRACT
Thirty-three patients with Bell's palsy underwent ophthalmic examination, including Schirmer testing, corneal sensitivity measurement, and electromyography. Sixteen patients returned for follow-up after one year. Sixty-one percent of the patients initially showed punctate fluorescein staining of the inferior cornea. Electromyographic studies demonstrate a high correlation between orbicularis function and the presence of corneal epithelial staining. Our results demonstrate a high frequency of minor corneal involvement in the acute phase of Bell's palsy. Healing of the epithelial defects follows improvement in orbicularis function.