ABSTRACT
We described a 35 years old female patient with bilateral visual loss and pain on eye movement, mild papillary edema in acute phase, arcuate scotoma and complementary test positive for antinuclear antibodies that did not respond to corticosteroid therapy. The lack of clinical criteria for systemic lupus erythematosus (SLE) didn't prevent the institution of the specific treatment with corticosteroids and azathioprine. After seven months the diagnosis was made after a skin manifestation of the disease. This case shows the value of the ocular complaints in systemic diseases. And how the ophthalmologic exam can help the clinician elaborating a diagnosis. It is also very important for ophthalmologists and rheumatologists due to the fact that it calls the attention to another diagnostic hypothesis in patients with nonspecific optic neuritis, even with inconclusive laboratory tests. Maybe some ocular findings deserve to be included to the diagnostic criteria already established for SLE.
Descrevemos caso de um paciente de 35 anos do sexo feminino, com perda visual bilateral associada à dor à movimentação ocular, edema papilar moderado na fase aguda, escotoma arqueado e exame complementar positivo para anticorpos antinucleares, que não responderam à terapia com corticosteróides. A falta de critérios clínicos para o lúpus eritematoso sistêmico (LES) não impediu a instituição do tratamento específico com corticosteróides e azatioprina. Depois de sete meses, o diagnóstico foi feito após uma manifestação da doença de pele. Este caso mostra o valor das queixas oculares em doenças sistêmicas e como o exame oftalmológico pode ajudar o clínico na elaboração de um diagnóstico. Também é muito importante para oftalmologistas e reumatologistas, devido ao fato de que chama a atenção para outra hipótese diagnóstica em pacientes com neurite óptica não-específica, mesmo com os testes laboratoriais conclusivos. Talvez alguns achados oculares merecem ser incluídos com os critérios de diagnóstico já estabelecido para o LES.
Subject(s)
Humans , Female , Adult , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/etiology , Optic Nerve Diseases/immunology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Ophthalmoscopy , Optic Nerve/pathology , Pregnenediones/therapeutic use , Skin/pathology , Azathioprine/therapeutic use , Biopsy , C-Reactive Protein/metabolism , Prednisolone/therapeutic use , Optic Nerve Diseases/drug therapy , Papilledema/pathology , Antibodies, Antinuclear/blood , Hydroxychloroquine/therapeutic use , Lupus Erythematosus, Systemic/drug therapyABSTRACT
The immune response of a group of patients with epidemical neuropathy and of controls was studied by the immunoblotting technique against proteins of the Coxsackie virus and the proteins of slow effect isolated in our laboratory. 13 sera of patients with epidemical neuropathy and 9 sera of controls were studied. Of the 13 sera studied, 8 (61.5%) recognized protein VPI and 2 sera (15.3%) protein VP0 of the strain 47.93. Of the 9 controls studied, 4 (44.4%) recognized protein VPI and 3 (33.3%) protein VP0 only. With the antigen prepared from the slow effect strain it was obtained a specific signal in 5 (38.5%) sera of patients and in 2 sera (22.5%) of controls. It should be stressed that in this last case the protein observed had a molecular weight of 41,300 D, and that its size was smaller than that of the preceding protein detected against the strain 47.93 was of 45,000 D.
Subject(s)
Antibodies, Viral/blood , Coxsackievirus Infections/immunology , Disease Outbreaks , Enterovirus/immunology , Optic Nerve Diseases/immunology , Peripheral Nervous System Diseases/immunology , Viral Proteins/immunology , Animals , Antibody Specificity , Blotting, Western , Chlorocebus aethiops , Coxsackievirus Infections/epidemiology , Coxsackievirus Infections/virology , Cuba/epidemiology , Enterovirus/classification , Enterovirus/isolation & purification , Humans , Molecular Weight , Optic Nerve Diseases/blood , Optic Nerve Diseases/epidemiology , Optic Nerve Diseases/virology , Peripheral Nervous System Diseases/blood , Peripheral Nervous System Diseases/epidemiology , Peripheral Nervous System Diseases/virology , Rabbits , Seroepidemiologic Studies , Vero Cells , Viral Proteins/chemistryABSTRACT
During the epidemic neuropathy occurred in Cuba from 1992 to 1993, viral isolations antigenically connected with Coxsackie viruses were obtained from the cerebrospinal fluid of patients. Virological, epidemiological, toxicologic, nutritional, immunological and histopathological investigations were made. Though the disease was related to toxic and nutritional factors, it has been impossible to identify the cause of the epidemic. Taking into consideration the results of the different investigations, we have formulated a comprehensive and multifactorial hypothesis to explain the physiopathological mechanism of the participation of the isolated viruses as mediators in a process of autoimmunity of the pathogeny of the disease.