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Cureus Sep 2022A 58-year-old man with recently diagnosed coccidioidal meningitis presented to the ED with a five-day history of headache, photopsia, blurred vision, and worsening...
A 58-year-old man with recently diagnosed coccidioidal meningitis presented to the ED with a five-day history of headache, photopsia, blurred vision, and worsening encephalopathy. His coccidioidal meningitis had responded well to fluconazole therapy, but three weeks later, he developed acute symptomatic worsening. Unfortunately, his clinical worsening coincided with Arizona's worst seasonal West Nile Virus (WNV) outbreak. He was ultimately found to have WNV neuroinvasive disease. Concurrent coccidioidal and WNV neuroinvasive diseases have not been described in the literature. Fortunately, he improved quickly to his normal baseline without neurologic deficits with supportive therapy for his WNV neuroinvasive disease and remains on lifelong antifungal therapy for coccidioidal meningitis.
PubMed: 36340535
DOI: 10.7759/cureus.29783 -
BMC Research Notes Aug 2015Digoxin intoxication results in predominantly digestive, cardiac and neurological symptoms. This case is outstanding in that the intoxication occurred in a nonagenarian... (Review)
Review
BACKGROUND
Digoxin intoxication results in predominantly digestive, cardiac and neurological symptoms. This case is outstanding in that the intoxication occurred in a nonagenarian and induced severe, extensively documented visual symptoms as well as dysphagia and proprioceptive illusions. Moreover, it went undiagnosed for a whole month despite close medical follow-up, illustrating the difficulty in recognizing drug-induced effects in a polymorbid patient.
CASE PRESENTATION
Digoxin 0.25 mg qd for atrial fibrillation was prescribed to a 91-year-old woman with an estimated creatinine clearance of 18 ml/min. Over the following 2-3 weeks she developed nausea, vomiting and dysphagia, snowy and blurry vision, photopsia, dyschromatopsia, aggravated pre-existing formed visual hallucinations and proprioceptive illusions. She saw her family doctor twice and visited the eye clinic once until, 1 month after starting digoxin, she was admitted to the emergency room. Intoxication was confirmed by a serum digoxin level of 5.7 ng/ml (reference range 0.8-2 ng/ml). After stopping digoxin, general symptoms resolved in a few days, but visual complaints persisted. Examination by the ophthalmologist revealed decreased visual acuity in both eyes, 4/10 in the right eye (OD) and 5/10 in the left eye (OS), decreased color vision as demonstrated by a score of 1/13 in both eyes (OU) on Ishihara pseudoisochromatic plates, OS cataract, and dry age-related macular degeneration (ARMD). Computerized static perimetry showed non-specific diffuse alterations suggestive of either bilateral retinopathy or optic neuropathy. Full-field electroretinography (ERG) disclosed moderate diffuse rod and cone dysfunction and multifocal ERG revealed central loss of function OU. Visual symptoms progressively improved over the next 2 months, but multifocal ERG did not. The patient was finally discharged home after a 5 week hospital stay.
CONCLUSION
This case is a reminder of a complication of digoxin treatment to be considered by any treating physician. If digoxin is prescribed in a vulnerable patient, close monitoring is mandatory. In general, when facing a new health problem in a polymorbid patient, it is crucial to elicit a complete history, with all recent drug changes and detailed complaints, and to include a drug adverse reaction in the differential diagnosis.
Topics: Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Digoxin; Electroretinography; Eye; Female; Humans; Visual Acuity
PubMed: 26298392
DOI: 10.1186/s13104-015-1367-6 -
Investigative Ophthalmology & Visual... May 2019Melanoma-associated retinopathy (MAR) is a paraneoplastic syndrome associated with cutaneous malignant melanoma (CMM). Visual symptoms include night blindness,...
PURPOSE
Melanoma-associated retinopathy (MAR) is a paraneoplastic syndrome associated with cutaneous malignant melanoma (CMM). Visual symptoms include night blindness, photopsia, and reduced-contrast sensitivity. An abnormal ERG b-wave and the presence of anti-bipolar cell autoantibodies, including autoantibodies reacting with the ON-bipolar cell TRPM1 channel, help to confirm the diagnosis. The goal of this study was to determine if CMM patients without visual symptoms also express anti-TRPM1 autoantibodies.
METHODS
Serum samples from 15 CMM patients were tested using three assays: immunofluorescent labeling of TRPM1-transfected HEK cells, immunofluorescent labeling of retinal sections from wild-type and TRPM1 knockout mice, and immunoblot detection of a bacterially produced recombinant TRPM1 peptide.
RESULTS
Serum specimens from 5 of the 15 CMM patients without declared visual symptoms were positive for anti-TRPM1 autoantibodies in at least one of the three assays. One of 50 control sera from patients not known to have cancer was also weakly reactive with the TRPM1 peptide.
CONCLUSIONS
Autoantibodies against TRPM1 are present in CMM patient sera without self-reported visual symptoms. Most patients had advanced (stage III and IV) disease and were undergoing aggressive treatments, including immunotherapy. It is unknown if immunotherapy affects the expression of TRPM1 autoantibodies. The presence of TRPM1 autoantibodies may predispose patients for MAR.
Topics: Animals; Autoantibodies; Case-Control Studies; Cells, Cultured; Humans; Melanoma; Mice; Paraneoplastic Syndromes, Ocular; Skin Neoplasms; TRPM Cation Channels; Melanoma, Cutaneous Malignant
PubMed: 31117125
DOI: 10.1167/iovs.19-26775 -
BMJ Case Reports Aug 2015
Topics: Adult; Humans; Light; Male; Retinal Neoplasms; Retinoblastoma
PubMed: 26243747
DOI: 10.1136/bcr-2015-211018 -
Indian Journal of Ophthalmology Jul 2021
Topics: Cataract; Cataract Extraction; Humans; Retinal Diseases; Vision Disorders
PubMed: 34146030
DOI: 10.4103/ijo.IJO_545_21 -
Journal of Ophthalmic Inflammation and... Dec 2021Multiple evanescent white dot syndrome (MEWDS) is a rare inflammatory eye condition affecting the outer retina as a consequence of choriocapillaris non perfusion. The... (Review)
Review
BACKGROUND
Multiple evanescent white dot syndrome (MEWDS) is a rare inflammatory eye condition affecting the outer retina as a consequence of choriocapillaris non perfusion. The pathophysiology of MEWDS will be discussed based clinical appraisal and on multimodal imaging appraisal.
METHODS
Narrative review and perspective opinion.
RESULTS
Literature review results helped us to put forward (1) the specific symptomatology (decreased/blurred vision, photopsia, subjective scotomas), (2) the ill-asserted character of clinical findings (foveal granularity, white dots in fundoscopy), (3) and the crucial importance of multimodal imaging with the diagnostic triad of ICGA hypofluorescent areas, BL-FAF hyperautofluorescent areas and loss/damage of IS/OS-ellipsoid zone on SD-OCT that characterise the disease and can practically help the clinician to diagnose MEWDS. A comprehensive alternative perspective of the disease was formulated.
CONCLUSIONS
The bulk of evidence that we are presenting in this review, thanks to new performing non-invasive and invasive imaging modalities, is sufficiently compelling to consider MEWDS as a primary choriocapillaritis/inflammatory choriocapillaropathy. Multimodal imaging allows the clinician to diagnose MEWDS with a high level of certainty and ensures a precise follow-up.
PubMed: 34921620
DOI: 10.1186/s12348-021-00279-7 -
Clinical & Experimental Optometry Sep 2010Multiple evanescent white dot syndrome (MEWDS) is a rare chorioretinal syndrome that usually presents with a unilateral, multifocal retinitis affecting mostly young... (Review)
Review
BACKGROUND
Multiple evanescent white dot syndrome (MEWDS) is a rare chorioretinal syndrome that usually presents with a unilateral, multifocal retinitis affecting mostly young women. The typical presentation includes multiple white spots extending from the posterior pole out to the mid-peripheral retina, possible vitritis and a granular appearance to the fovea. Symptoms can include a prodromal flu-like episode, photopsia, scotoma and decreased vision. Ophthalmoscopy is the most common method of diagnosing MEWDS but fluorescein angiography, electrodiagnostic testing, visual fields and optical coherence tomography can help confirm the diagnosis. MEWDS is usually a self-limiting condition with complete visual recovery, although subsequent retinal sequellae may be possible.
CASE REPORT
A healthy 21-year-old myopic female presented with unilateral, sudden onset of photopsia, blurred vision and a 'grey area' in the temporal visual field. Initial examination found a vitritis, maculopathy and the presence of white dots in all four quadrants of the mid-peripheral retina. A retinal ophthalmologist confirmed the diagnosis of MEWDS. Although the patient was less than compliant with the retinal specialist's recommendations, a subsequent examination found complete resolution of signs and symptoms.
CONCLUSIONS
In the primary optometric setting, the uncommon syndrome known as MEWDS must be considered when the common symptoms of photopsia and blurred vision, combined with the atypical clinical presentation of white spots in the fundus appear in an otherwise healthy patient.
Topics: Adult; Female; Humans; Indocyanine Green; Retinal Diseases; Syndrome; Tomography, Optical Coherence; Young Adult
PubMed: 20718788
DOI: 10.1111/j.1444-0938.2010.00507.x -
Cureus Feb 2023Introduction Pregnancy-induced hypertension (PIH) is a hypertensive disorder in pregnancy that occurs after 20 weeks of pregnancy in the absence of previously known...
Introduction Pregnancy-induced hypertension (PIH) is a hypertensive disorder in pregnancy that occurs after 20 weeks of pregnancy in the absence of previously known hypertension. PIH is a common and serious complication accompanying pregnancy. Pre-eclampsia and eclampsia are multisystem disorders that can involve end organs like kidneys, liver, eyes, haematopoietic system and placenta. Though ocular involvement is not uncommon in PIH, ocular examination is not always done in all cases of PIH. Timely detection of changes in retinal vasculature can be a hint to the underlying changes in the vascular system of the various end organs of the human body including placental circulation. Adequate management of PIH is very important for both fetal and maternal well-being. Aim To evaluate the ocular manifestations in women affected by PIH (mild pre-eclampsia, severe pre-eclampsia and eclampsia) presenting to a tertiary-level hospital. Methodology This was a hospital-based cross-sectional study carried out for a period of one year at a tertiary-level hospital. A total of 120 subjects diagnosed as cases of pre-eclampsia/eclampsia admitted to the eclampsia ward of the obstetric unit formed the study population. After taking history, a detailed ocular examination was done for all patients and the findings were noted. Results The mean age of the study population was 31.91 ± 4.38 years (range 21 to 39 years). The mean gestational age was 30.89 ± 3.98 weeks. Fifty-three (44.17%) were primigravida, 64 (53.33%) were multiparous, and three (2.5%) were grand multiparous. Sixty-two (51.67%) had mild pre-eclampsia, 50 (41.67%) had severe pre-eclampsia and eight (6.67%) had eclampsia. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) recorded in the study were 155.32 ± 11.89 mmHg and 104.3 ± 11.41 mmHg respectively. Ocular symptoms were present in 43 (35.83%) participants. Blurring of vision (19.17%) was the commonest ocular symptom observed in the study population followed by photopsia (13.33%), diplopia (9.17%), intermittent loss of vision (5.83%), ocular pain (6.67%), and scotoma (1.67%). Systemic symptoms included headache (11.67%), epigastric pain (3.33%), and nausea (5%). Anterior segment findings like conjunctival congestion, lid edema, and subconjunctival hemorrhage each accounted for 1.67% of the study population. Fundal changes were present in 33.33% of cases. Arteriolar narrowing was the commonest fundal finding amounting to 15.83%, followed by arteriovenous (AV) crossing changes also in 15.83%, cotton wool spots in 5.83%, retinal haemorrhages in 8.33%, papilledema in 2.5%, and choroidal infarcts in 1.67% participants. Grade 1 hypertensive retinopathy was observed in 15.83% of participants, grade 2 in 8.33% of participants, grade 3 in 6.67% of participants and grade 4 in 2.5% of participants. The mean SBP and mean DBP were high among those with fundal changes (163.35 ± 10.25 mmHg and 111.15 ± 10.29 mmHg) compared to those without fundal changes (151.3 ± 10.58 mmHg and 100.88 ± 10.41 mmHg). This was statistically significant. Proteinuria showed significant correlation with retinal changes. Conclusion The retinal vasculature changes correlate with the severity of hypertension, hence, it is very important to seek ophthalmologic opinion for evaluation, diagnosis and prompt management of PIH.
PubMed: 36925976
DOI: 10.7759/cureus.34887 -
American Journal of Ophthalmology Case... Jun 2023To describe a case of bilateral retinal pigmentary changes in the setting of immune checkpoint inhibitor therapy (ICIT).
PURPOSE
To describe a case of bilateral retinal pigmentary changes in the setting of immune checkpoint inhibitor therapy (ICIT).
OBSERVATIONS
A 69-year-old man with a history of advanced cutaneous melanoma was started on combination ICIT with nivolumab and ipilimumab and stereotactic body radiation therapy. Soon after, he developed photopsias and nyctalopia with findings of discrete retinal pigmentary changes bilaterally. Initial visual acuities were 20/20 and 20/30 in the right and left eye, respectively. Multi-modal imaging revealed sub-retinal deposits with progressive changes in pigmentation and autofluorescence, associated with decreased peripheral fields on formal perimetry. A full-field electroretinogram revealed attenuated and delayed a- and b-waves. Positive serum retinal autoantibodies were identified. The patient developed left-sided optic nerve edema and center-involving cystoid macular edema which improved after treatment with sub-tenon's triamcinolone.
CONCLUSIONS
The use of ICIT has greatly expanded in oncologic practice with subsequent increases in immune related adverse events that pose significant systemic and ophthalmologic morbidities. We propose that the new retinal pigmentary changes seen in this case are the sequelae of an autoimmune inflammatory response against pigmented cells. This adds to the rare side effects that may occur after ICIT.
PubMed: 37131528
DOI: 10.1016/j.ajoc.2023.101849 -
WMJ : Official Publication of the State... Dec 2019We report 3 ocular syphilis cases that highlight the increasing incidence, variable presentation, diagnostic challenges, and treatment considerations of this potentially...
INTRODUCTION
We report 3 ocular syphilis cases that highlight the increasing incidence, variable presentation, diagnostic challenges, and treatment considerations of this potentially visionthreatening disease.
CASE SERIES
A 39-year-old woman with diabetes and intravenous (IV) drug use presented with 3 weeks of decreased vision, left-eye photopsia, and rash. A 52-year-old man who has sex with men (MSM), presented with a 1-month history of upper respiratory infection-like symptoms, right-eye scotoma, redness, headache, and muffled hearing. A 24-year-old man with a history of MSM presented with right-eye scotoma and a history of transaminitis, rash, and systemic symptoms months prior.
DISCUSSION
Syphilis rates are increasing. Each patient presented with nonspecific symptoms that, in retrospect, were early signs of infection. Vision recovery depends on the extent of ocular involvement, early recognition, and prompt initiation of appropriate therapy.
CONCLUSION
Ocular syphilis must be considered in at-risk groups, but systemic signs may precede vision changes. Diagnosis requires a high index of suspicion and treatment with IV penicillin is effective.
Topics: Adult; Anti-Bacterial Agents; Diabetes Mellitus, Type 1; Eye Infections, Bacterial; Female; Homosexuality, Male; Humans; Male; Middle Aged; Penicillins; Risk Factors; Syphilis
PubMed: 31978289
DOI: No ID Found