Fungal endophthalmitis. An experimental study with a review of 17 human ocular cases.

Pseudallescheria boydii is an opportunistic fungus that is histologically indistinguishable from Aspergillus fumigatus. Pseudallescheria boydii has been reported to cause endophthalmitis, orbital cellulitis, and corneal ulceration and is, thus, important to the ophthalmologist. A clinical review of 17 patients with P boydii ophthalmic infections is presented. In addition, animal models of endophthalmitides caused by A fumigatus and P boydii were created and compared. Dutch-Belted rabbits used for the experimental models were immunosuppressed with methylprednisolone acetate (Depomedrol). Exogenous and endogenous models of P boydii endophthalmitis were created in immunocompetent and immunosuppressed animals. An exogenous model of A fumigatus endophthalmitis was created in immunocompetent and immunosuppressed animals for comparison. The clinical and histopathologic features of A fumigatus and P boydii endophthalmitis are indistinguishable in the immunocompetent and immunosuppressed exogenously infected rabbits. Endogenous P boydii endophthalmitis has a similar fundus appearance to that caused by Nocardia asteroides.

Necrobiotic xanthogranuloma with paraproteinemia. Case report and a pathogenetic theory.

Necrobiotic xanthogranuloma with paraproteinemia is a clinical and histopathological entity characterized by xanthelasma-like lesions in the periorbital region and elsewhere, paraproteinemia, leukopenia, and an elevated erythrocyte sedimentation rate. Multiple myeloma has been reported as an accompanying feature in several cases. We examined a patient with necrobiotic xanthogranuloma and multiple myeloma in whom an IgG kappa monoclonal protein was identified in serum, urine, bone marrow, and bilateral periorbital lesions. We speculate that increased serum immunoglobulins complexed with lipid may be deposited in the skin, leading to a foreign body giant cell reaction and the subsequent characteristic histopathologic features of necrobiotic xanthogranuloma.

Treatment of thrombotic thrombocytopenic purpura with plasma exchange: five cases.

Five patients with thrombotic thrombocytopenic purpura (TTP) were treated with corticosteroids, plasma exchange (PE), and antiplatelet agents. ABO- and Rh-compatible fresh-frozen plasma (FFP) was used as the replacement fluid. None of the patients received FFP infusion without PE. The patients were followed for 14-32 months after initial treatment. Four of the five patients are in complete clinical remission. One responded to plasma exchange but died of heart disease. This report shows an 80% survival rate which is markedly better than that without the use of PE and FFP infusion. We found dramatic clinical and hematologic improvement beginning shortly after initiating treatment. Two patients showed reversal of their initial clinical and hematologic improvement when PE was discontinued, despite continuing treatment with antiplatelet drugs and in one with corticosteroids. Both patients showed hematologic and clinical remission after reinstitution of PE. None of the survivors had any neurologic or renal deficit. They were maintained on aspirin and dipyridamole for 1 year after discharge.

Plexiform (multinodular) schwannoma. A tumor simulating the plexiform neurofibroma.

We describe a rare variant of schwannoma characterized by a interconnecting multinodular growth mimicking a plexiform neurofibroma. The schwannoma recurred twice. The second recurrence was not excised and has not increased in size for 1 1/2 years. The patient is alive and well, 3 years and 4 months after the first excision with no clinical evidence of metastasis.