Oclusión de la arteria central de la retina como complicación postransfusional de glóbulos rojos / Central retinal artery occlusion as a post-transfusion complication of red blood cells

Mujer de 32 años con antecedente de miomatosis uterina y metrorragias a repetición durante seis meses que condicionan una concentración de hemoglobina de 6,5 g/dL con requerimiento de transfusión de eritrocitos. Presentó una hora postransfusión, pérdida visual súbita e indolora del ojo derecho (OD) sin otra sintomatología, siendo remitida al departamento de Neuro-oftalmología. Al ingreso su agudeza visual corregida fue movimiento de manos en OD y 0,6 en el izquierdo (OI). El segmento anterior fue normal, salvo un defecto pupilar aferente relativo en OD. Funduscópicamente el OD resaltó una retina pálida difusa con mancha rojo cereza, compatible con oclusión de la arteria central de la retina, OI normal. Se intentó manejo sin mejoría. Los estudios oculares corroboraron isquemia retiniana en OD. Durante la evaluación sistémica los estudios de neuroimágenes, paneles autoinmunes y hematológicos fueron negativos, por lo que se atribuyó dicha complicación a la transfusión de glóbulos rojos (AU)

A 32-year-old woman presented with a history of uterine myomatosis and repeated bleeding for 6 months. This produced a haemoglobin concentration of 6.5 g/dL, with a requirement for a red blood cell transfusion. One hour after the transfusion, she presented with a sudden and painless loss of vision in the right eye (RE). As she had no other symptoms, she was referred to the Neuro-Ophthalmology Department. On admission, her corrected visual acuity was hand movement in RE, and 0.6 in the left eye (LE). The anterior segment was unremarkable, except for a relative afferent pupillary defect in RE. In the fundus examination, the RE showed a diffuse pale retina with a cherry spot, consistent with occlusion of the central artery of the retina. Management was attempted but with no improvement. The studies corroborated retinal ischaemia in RE. During the systemic evaluation, the neuroimaging, autoimmune and haematology studies were negative, thus this complication was attributed to the red blood cell transfusion (AU)

Central retinal artery occlusion as a post-transfusion complication of red blood cells. / Oclusión de la arteria central de la retina como complicación postransfusional de glóbulos rojos.

A 32-year-old woman presented with a history of uterine myomatosis and repeated bleeding for 6 months. This produced a haemoglobin concentration of 6.5 g/dL, with a requirement for a red blood cell transfusion. One hour after the transfusion, she presented with a sudden and painless loss of vision in the right eye (RE). As she had no other symptoms, she was referred to the Neuro-Ophthalmology Department. On admission, her corrected visual acuity was hand movement in RE, and 0.6 in the left eye (LE). The anterior segment was unremarkable, except for a relative afferent pupillary defect in RE. In the fundus examination, the RE showed a diffuse pale retina with a cherry spot, consistent with occlusion of the central artery of the retina. Management was attempted but with no improvement. The studies corroborated retinal ischaemia in RE. During the systemic evaluation, the neuroimaging, autoimmune and haematology studies were negative, thus this complication was attributed to the red blood cell transfusion.

Manifestaciones neurooftalmológicas del síndrome de POEMS / Neuro-ophthalmological manifestations of POEMS syndrome

Varón de 38 años que acude por un cuadro de dos meses de evolución caracterizado por síndrome constitucional, fiebre, poliadenopatías y hepatoesplenomegalia. Además indicó cefalea, visión borrosa bilateral y miodesopsias. La agudeza visual corregida fue de 20/50 y 20/200. El segmento anterior no mostraba alteración. El fondo de ojo evidenció discos sobreelevados y borrados, acompañados de desprendimiento seroso del neuroepitelio mayor en el ojo izquierdo. Los estudios de ambos ojos mostraron un campo visual con aumento de la mancha ciega; la angiografía fluoresceínica mostró hiperfluorescencia tardía discal; el electrorretinograma evidenció compromiso de conos y bastones; el potencial visual detectó alteración en la percepción y la conducción de estímulos. Los estudios de imagen fueron esencialmente normales. Durante su hospitalización presentó paraparesia, insuficiencia renal, endocrinopatía, alteraciones dérmicas y lesiones osteoblásticas con biopsias negativas. Se documentó gammapatía monoclonal, planteándose el diagnóstico de síndrome de POEMS -Polineuropatía, Organomegalia, Endocrinopatía, Gammapatía Monoclonal y alteraciones dermatológicas e iniciándose quimioterapia con dexametasona/melfalán, con buena respuesta a los 3 meses

The cases is presented of a 38 year-old male with a constitutional syndrome, fever, multiple swollen lymph nodes, and hepatosplenomegaly of 2 months onset. There was also mention of headache, bilateral blurred vision, and myiodesopsias. Best correct visual acuity was 20/50 and 20/200. The anterior segment was unremarkable. The fundus of both eyes showed raised and erased discs, accompanied by serous detachment, greater in the left eye. Complementary studies of both eyes showed a visual field with increased blind spot; fluorescein angiography indicated late disc hyperfluorescence. The electroretinogram showed compromise of cones and rods, and the visual evoked potential detected alteration in the perception and conduction of stimuli. The imaging studies were essentially normal. During his hospital admission he presented with paraparesis, renal failure, endocrinopathy, skin alterations, and osteoblastic lesions with negative biopsies. Monoclonal gammopathy was documented, and the diagnosis of POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes) syndrome was made. The chemotherapy started with dexamethasone/melphalan, with a good response at 3 months

Neuro-ophthalmological manifestations of POEMS syndrome. / Manifestaciones neurooftalmológicas del síndrome de POEMS.

The cases is presented of a 38 year-old male with a constitutional syndrome, fever, multiple swollen lymph nodes, and hepatosplenomegaly of 2 months onset. There was also mention of headache, bilateral blurred vision, and myiodesopsias. Best correct visual acuity was 20/50 and 20/200. The anterior segment was unremarkable. The fundus of both eyes showed raised and erased discs, accompanied by serous detachment, greater in the left eye. Complementary studies of both eyes showed a visual field with increased blind spot; fluorescein angiography indicated late disc hyperfluorescence. The electroretinogram showed compromise of cones and rods, and the visual evoked potential detected alteration in the perception and conduction of stimuli. The imaging studies were essentially normal. During his hospital admission he presented with paraparesis, renal failure, endocrinopathy, skin alterations, and osteoblastic lesions with negative biopsies. Monoclonal gammopathy was documented, and the diagnosis of POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes) syndrome was made. The chemotherapy started with dexamethasone/melphalan, with a good response at 3 months.

Clinical relevance of incidental finding of focal uptakes in the colon during 18F-FDG PET/CT studies in oncology patients without known colorectal carcinoma and evaluation of the impact on management.

AIMS: To assess the significance and the impact of focal FDG uptake in the colon in oncology patients without known colorectal carcinoma. MATERIALS AND METHODS: A retrospective study was undertaken on 2,220 (18)F-FDG PET/CT studies carried out consecutively in the Nuclear Medicine Department in our hospital from 2 December 2008 to 31 May 2010. Inclusion criteria were patients with abnormal (18)F-FDG uptake in colorectal area that could not be explained (or not previously known) by their clinical histories. Patients previously diagnosed with colorectal carcinoma were excluded. A total of 86 patients (57 male, average age 63.4, range 46-85) were finally included. Colonoscopy with biopsy was established as a reference test. The impact of these findings on the diagnostic-therapeutic management in these patients was evaluated. RESULTS: A colonoscopy was performed in 54 of the 86 patients, this examination not having been done up-to-date in the remaining 32 patients. Biopsy was obtained in 43 lesions of the 54 patient in whom a colonoscopy was performed. Colon disease was detected in 49 of these 54 patients, obtaining 54 FDG incidental foci which corresponded to 10 previously unsuspected primary colorectal carcinoma, 3 metastases, 27 adenomatous polyps with different degrees of dysplasia and 14 inflammatory processes. In the remaining 5 patients, the colonoscopy was normal. PET/CT modified the diagnostic and treatment management in most of the patients (49/54, that is 91%). CONCLUSIONS: These results confirm the need to determine the cause of abnormal (18)F-FDG colorectal uptakes in the PET/CT studies by using colonoscopy and biopsy. This approach allows for the detection and early treatment of malignant and premalignant lesions.