Clinical features and presentation of infectious scleritis from herpes viruses: a report of 35 cases.

PURPOSE: To describe clinical features and presentation of infectious scleritis resulting from herpes viruses. DESIGN: Retrospective case series. PARTICIPANTS: Thirty-five patients out of 500 with scleritis. METHODS: We reviewed the electronic health records of 500 patients with scleritis, 35 of whom were diagnosed with herpes virus infection, seen at 2 tertiary referral centers. We studied the clinical features and ocular complications of this subset of patient with scleritis. MAIN OUTCOME MEASURES: Correlation between classification, severity, and symptoms (i.e., pain) and diagnosis of herpetic-associated scleritis. Vision loss, presence of associated uveitis, keratitis, glaucoma, or systemic disease were documented over the follow-up period. Other outcome measures included epidemiologic data: age, gender, laterality, visual acuity, duration of symptoms, and underlying systemic or ocular diseases. RESULTS: Of 500 patients with scleritis, 47 (9.4%) had an underlying infectious cause. Thirty-five (74.4%) of these were diagnosed with herpes virus infection, 5 (10.6%) with tuberculosis, and the remaining 7 (14.8%) with other infectious disease. Patients with herpes-associated scleritis were analyzed as a group and then compared with those with idiopathic scleritis. Most patients with herpetic scleritis presented with acute (85.7%) and unilateral (80%) scleral inflammation. Pain was moderate or severe in 68.6% of the patients. The most common type of scleritis was diffuse anterior in 80% (n = 28), followed by nodular anterior 11.4% (n = 4), and necrotizing in 8.6% (n = 3). Necrotizing anterior scleritis was more commonly seen in patients with herpetic scleritis versus patients with idiopathic disease (8.6% vs 1.2%; P<0.05). Unilaterality was also more common in herpetic scleritis (80%) than in idiopathic disease (56.7%; P<0.05). Vision loss was significantly greater in herpetic than idiopathic scleritis (34.3% vs 11.5%; P<0.001). CONCLUSIONS: The association between scleritis and infectious disease may be higher than previously reported by other series. Herpes viruses account for 7% of all scleritis cases and its diagnosis may be challenging when there is not a classically diagnostic clinical picture. We present the observed clinical features of herpetic scleritis and describe the clinical differences at presentation between patients with idiopathic scleritis and those with herpes infection.

Anti-TNF-alpha-induced lupus in patients with non-infectious uveitis.

PURPOSE: Anti-TNF-α-induced lupus (ATIL) is a rare condition considered as a drug-induced lupus (DIL) in patients under anti-TNF-α therapies. Nowadays it is still unclear if ATIL is a classical DIL or represent a distinct syndrome. Some characteristics of DIL have been described specifically associated with patients with lupus-like syndrome receiving anti-TNF-α therapy: the severity of the disease, incidence/prevalence of dsDNA antibodies (anti-dsDNA) and hypocomplementaemia. The objective of this study is to describe the development of ATIL in patients with non-infectious uveitis in a single tertiary center. METHODS: Retrospective description of a case series. RESULTS: We describe three patients with noninfectious uveitis (NIU) of different etiologies who developed antinuclear antibody (ANA) and anti-dsDNA antibody positivity, arthritis and, in one case, skin lesions under adalimumab treatment. The condition resolved in all of them after adalimumab withdrawal. Corticosteroids were required in one patient, non-steroidal anti-inflammatory drugs in two patients, and hydroxychloroquine in one of them. None required another immunosuppressive drug. A subsequent control of the NIU could continue to be carried out without anti-TNF-α therapy in two patients and in the remaining a switch was made to another anti-TNF-α (golimumab). CONCLUSION: The current report describes three cases of ATIL in patients with different types of NIU which share some common features: ANA positivity, articular symptoms, and a temporal relationship between symptoms onset and anti-TNF-α treatment. A review of the literature and comparison with the few previous reported ATIL cases was conducted as well.

Ocular findings in patients with alopecia areata: role of ultra-wide-field retinal imaging.

Alopecia areata is understood as an autoimmune disease T cell-mediated mainly involving hair follicles in humans. It is a multifactorial aetiologic disease characterised by non-scarring alopecia and asymptomatic areas, affecting approximately 2 % of dermatology patients. Recent studies suggest that the pathogenesis of AA plays an important role in the association of certain HLA groups, neuroendocrine parameters and immunogenic factors. During 3 months (March to May 2013) at Hospital Clínic de Barcelona, 22 patients with severe alopecia areata underwent ophthalmic examination to determine whether there were ocular findings in the following parameters: Best-corrected visual acuity on decimal Snellen optotype, anterior segment slit-lamp examination and photograph, intraocular pressure measurement and dilated fundoscopy. Ultra-wide-field retinal imaging with or without red-free photograph was carried out with the Optomap 200 Tx (Optos, DunFermline, UK). Forty-four eyes of 22 patients were analysed [15 females (68.2 %)]. The mean age was 38.9 (SD 13.7) and mean time of evolution was 19.9 years (SD 16.3). Alopecia areata clinical patterns were multifocal [n = 10 (45.5 %)], universalis [n = 7 (31.8 %)], totalis [n = 3 (13.6 %)] and focal [n = 2 (9.1 %)]. Best-corrected visual acuity was 1.0 in almost all patients, but only three eyes (6.8 %) had vision of 0.7. Ocular findings were as follows: madarosis [n = 7 partial loss of eyelashes (31.85 %) and n = 4 total loss (18.2 %)], lens changes [n = 4 (18.2 %)], cataract [n = 3 (13.65 %)]. Ultra-wide fundus photography examination showed peripheral drusen [n = 17 eyes (38.6 %)], white-without-pressure changes [n = 8 eyes (18.22 %)] and peripheral retinal degenerations [n = 3 eyes (6.81 %)]. Ocular findings in patients with alopecia areata are reported and discussed by dermatologic and ophthalmic evaluation.