Manifestación clínica ocular inusual de la leptospirosis / Unusual ocular clinical manifestation of leptospirosis

CASO CLÍNICO: Se presenta un caso clínico poco frecuente de una mujer de 15 años afectada por múltiples desprendimientos serosos bilaterales de retina y epitelio pigmentario. Con el diagnóstico clínico y de laboratorio (inmunofluorescencia indirecta [IFI] IgG 1/160 e IgM 1/160) de leptospirosis se realizó un examen oftalmológico completo, angiofluoresceingrafía, autofluorescencia y tomografía de coherencia óptica y se siguió al paciente durante 2 años. Discusión: Los desprendimientos serosos bilaterales y múltiples de la retina y del epitelio pigmentario pueden ser una complicación de la leptospirosis sistémica, zoonosis causada por Leptospira. Sin una historia médica detallada, puede permanecer sin ser diagnosticada, principalmente porque puede imitar otras enfermedades más frecuentes. Puede ser prudente preguntar a los pacientes sobre contacto con mascotas

CLINICAL CASE: An uncommon case is presented of a 15 year-old girl with bilateral, multiple serous detachments of retina and retinal pigment epithelium. With clinical and laboratory (IgG 1/160 and IgM 1/160, using an indirect immunofluorescence assay) diagnoses of leptospirosis, a complete ophthalmic examination, fluorescein angiography, autofluorescence and optical coherence tomography were performed, and the patient was followed for two years. DISCUSSION: Bilateral, multiple serous detachments of retina and retinal pigment epithelium can be a complication of systemic leptospirosis, a zoonotic disease caused by Leptospira. Without a detailed medical history it may be underdiagnosed, mainly because it can mimic other more common diseases. It may be prudent to ask patients regarding contact with pets

Tubérculo coroideo asintomático en un paciente con enfermedad de Crohn en tratamiento con adalimumab / Asymptomatic choroidal tubercle in a patient with Crohn's disease on adalimumab treatment

Introducción: Adalimumab, un antifactor de necrosis tumoral que se utiliza en la enfermedad de Crohn activa (EC), se asocia con un mayor riesgo de tuberculosis. Caso clínico: Se describe el caso de un varón de 48 años con EC activa en tratamiento con adalimumab. Después de 3 meses desarrolló una tuberculosis pulmonar miliar, y en un estudio oftalmológico se encontró un tubérculo coroideo no reactivo solitario temporal superior al disco óptico. La angiofluoresceingrafía mostró hiperfluorescencia tardía. Con la tomografía de coherencia óptica se observó una masa plana sin desprendimiento seroso de retina. El tubérculo coroideo regresó lentamente con la terapia antituberculosa. Discusión: En pacientes con EC y en tratamiento con adalimumab, un tubérculo coroideo puede presentarse sin sintomatología vítreo-retiniana (AU)

Introduction: Adalimumab, an anti-tumour necrosis factor alpha therapy for active Crohn's disease (CD), is associated with increased risks of tuberculosis infection. Case report: The case is presented of a 48 year-old male with active CD on treatment with adalimumab. After three months, he developed a miliary pulmonary tuberculosis infection, with a solitary non-reactive choroidal tubercle temporal-superior to the optic disc being found in an ophthalmological study. Fluorescein angiography showed late hyperfluorescence in a staining pattern. Optic coherence tomography showed a flat mass without serous retinal detachment. The choroidal tubercle slowly regressed with antituberculosis therapy. Discussion: Choroidal tubercles with no vitreo-retinal symptomatology can be present in patients with CD and on treatment with adalimumab (AU)

Unusual ocular clinical manifestation of leptospirosis. / Manifestación clínica ocular inusual de la leptospirosis.

CLINICAL CASE: An uncommon case is presented of a 15 year-old girl with bilateral, multiple serous detachments of retina and retinal pigment epithelium. With clinical and laboratory (IgG 1/160 and IgM 1/160, using an indirect immunofluorescence assay) diagnoses of leptospirosis, a complete ophthalmic examination, fluorescein angiography, autofluorescence and optical coherence tomography were performed, and the patient was followed for two years. DISCUSSION: Bilateral, multiple serous detachments of retina and retinal pigment epithelium can be a complication of systemic leptospirosis, a zoonotic disease caused by Leptospira. Without a detailed medical history it may be underdiagnosed, mainly because it can mimic other more common diseases. It may be prudent to ask patients regarding contact with pets.

Anormalidad en la visión del color como única manifestación de hidrocefalia normotensiva / Colour vision abnormality as the only manifestation of normal pressure hydrocephalus

CASO CLÍNICO: Presentamos el caso de un paciente varón de 73 años que acudió refiriendo visión en blanco y negro. La tomografía computarizada demostró hidrocefalia normotensiva (HNT). No se llegó a realizar resonancia magnética porque el paciente renunció a ser sometido a nuevos exámenes. DISCUSIÓN: La acromatopsia puede ser la primera o la única clínica de HNT. Puede ser prudente preguntar a los pacientes con HNT con respecto a la visión de color

CLINICAL CASE: The case is presented of a 73-year-old male patient who referred to having black and white vision. Computed tomography showed normal pressure hydrocephalus (NPH). Magnetic resonance imaging was not performed because the patient refused to undergo further examinations. DISCUSSION: Achromatopsia may be the first or only NPH symptom. It may be prudent to ask patients with NPH regarding colour vision

Colour vision abnormality as the only manifestation of normal pressure hydrocephalus. / Anormalidad en la visión del color como única manifestación de hidrocefalia normotensiva.

CLINICAL CASE: The case is presented of a 73-year-old male patient who referred to having black and white vision. Computed tomography showed normal pressure hydrocephalus (NPH). Magnetic resonance imaging was not performed because the patient refused to undergo further examinations. DISCUSSION: Achromatopsia may be the first or only NPH symptom. It may be prudent to ask patients with NPH regarding colour vision.

Asymptomatic choroidal tubercle in a patient with Crohn's disease on adalimumab treatment. / Tubérculo coroideo asintomático en un paciente con enfermedad de Crohn en tratamiento con adalimumab.

INTRODUCTION: Adalimumab, an anti-tumour necrosis factor alpha therapy for active Crohn's disease (CD), is associated with increased risks of tuberculosis infection. CASE REPORT: The case is presented of a 48 year-old male with active CD on treatment with adalimumab. After three months, he developed a miliary pulmonary tuberculosis infection, with a solitary non-reactive choroidal tubercle temporal-superior to the optic disc being found in an ophthalmological study. Fluorescein angiography showed late hyperfluorescence in a staining pattern. Optic coherence tomography showed a flat mass without serous retinal detachment. The choroidal tubercle slowly regressed with antituberculosis therapy. DISCUSSION: Choroidal tubercles with no vitreo-retinal symptomatology can be present in patients with CD and on treatment with adalimumab.

Hematoma orbitario en hipertensión maligna / Orbital haematoma in malignant hypertension

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La historia clínica en pacientes oftalmológicos tratados con complejos multivitamínicos / Clinical history in ophthalmological patients treated with multivitamin complexes

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