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Toxoplasma gondii
Published in Peter D. Walzer, Robert M. Genta, Parasitic Infections in the Compromised Host, 2020
Toxoplasma can infect any cell in the brain, but specific focal neurological symptoms vary, depending on the areas of the brain affected. However, there is a tendency for Toxoplasma to cause disease in the brain stem, basal ganglia, and the pituitary. With brain-stem involvement, neurological symptoms such as ataxia, limb dysmetria, and cranial nerve palsies are not uncommon. Choreiform movements and choreoathetosis have been found in patients with basal ganglia infection. Acquired hydrocephelus may also develop (316a). Blindness may occur as a result of chorioretinitis or involvement of the visual cortex of the brain. Lesions of the pituitary and hypothalmus have been mentioned in cases of central nervous system toxoplasmosis (11), but no evidence of functional pituitary insufficiency has been demonstrated. Recently, Milligan et al. (317) described a patient with panhypopituitarism due to toxoplasma infection of the pituitary.
Autologous Stem Cell Transplantation in Relapsing Polychondritis
Published in Richard K. Burt, Alberto M. Marmont, Stem Cell Therapy for Autoimmune Disease, 2019
Falk Hiepe, Andreas Thiel, Oliver Rosen, Gero Massenkeil, Gerd-Rüdiger Burmester, Andreas Radbruch, Renate Arnold
Now, after 55 months of follow-up, the patient is still in complete remission from the disease, as defined by the disappearance of all clinical symptoms and signs of polychondritis. Corticosteroid therapy was gradually reduced from 50 mg/day methylprednisolone before ASCT to 5 mg/d prednisolone 12 months after ASCT. In the absence of clinical signs of the disease, prednisolone was further tapered and withdrawn 36 months after ASCT. Forty-five months after ASCT, the patient suddenly complained of impaired vision in the right eye. The ophthalmologic examination revealed chorioretinitis. The serologic data confirmed our suspicion of a reactivation of Toxoplasma infection. The visual disturbance resolved completely under antibiotics. Nevertheless, this incident suggests that the patient’s immune system—which had apparently returned to normal after ASCT—might be weakened and susceptible to opportunistic infections.
Pathogenesis and Immunotherapy of Cogan’s Syndrome*
Published in George S. Eisenbarth, Immunotherapy of Diabetes and Selected Autoimmune Diseases, 2019
Barton F. Haynes, Nancy B. Allen, C. Christine Cox, Rex M. McCallum, L. Michael Cobo
Patient 1 had severe chorioretinitis progressing to blindness in the left eye, and uveitis, choroiditis, and subretinal neo vascular membrane fonnation around the macula in the right eye. Prednisone therapy was not efficacious in Patient 1, and because of the patient’s age, after laser treatment of the subretinal membrane it was elected to enter the patient on the cyclosporine A protocol rather than risk gonadal injury due to cyclophosphamide. Two weeks after the initiation of therapy with 5 mg/kg/d of cyclosporine A, vitreal inflammatory cells were markedly decreased. At follow-up at 18 months, the patient remained asymptomatic on 1 mg/kg cyclosporine A with diminished signs of vitreal and retinochoroidal inflammation, and no progression of the preexisting subretinal neovascular membrane.
Macular Necrotizing Retinitis as a Presenting Feature of Atypical Fulminant SSPE: A Case Report
Published in Ocular Immunology and Inflammation, 2023
Amruta More, Jayanti Singh, Nitin Chandak, Sachin B. Shetty, Alok Sen
Ophthalmic manifestations can precede the onset of neurological disorder by a few weeks to a few years. In a study done by Serdaroglu et al, it was found that patients of SSPE who were treated before the development of neurological signs had a fairly good prognosis.7 The most common ophthalmic manifestation is focal chorioretinitis. Macular lesions include retinal pigment epithelial changes, macular edema, macular hemorrhages, retinochoroiditis, and serous retinal detachment. Other features include optic neuritis, papilledema, optic atrophy, retinal edema and hemorrhages, and nystagmus. The most common cause of vision loss is cortical blindness.3 The absence of vitritis, vasculitis, and satellite lesions help in differentiating SSPE from other causes of retinitis like toxoplasmosis, ocular tuberculosis, and Behcet’s disease.8
Risk factors for ophthalmologic involvement and ocular findings in patients diagnosed with fungemia in a high-complexity hospital in the city of Medellín, Colombia
Published in Annals of Medicine, 2022
Marcos Restrepo Arango, Juan Camilo Cadavid Usuga, Luis Fernando Velazquez Ossa, Jorge Hernando Donado Gómez, Laura Nataly Higuita Duque, Juan Pedro Neira Gomez
The rate of ocular involvement by fungemia has been described in several studies, ranging from 0.9% to 40% [5], depending on whether endophthalmitis or chorioretinitis is evaluated, with endophthalmitis showing the lowest rates of involvement. For our study the rate was 22.68%, very similar to the findings found by Son et al. [18], 21.5%. The difference between studies was that Son’s only took into account Candida fungemia, whereas ours considered any type of fungus. Ueda et al. [13] found a percentage of Candida infection of 77.9%, similar to ours, which was 81.4% for their species C. albicans and higher for all Candida species with 91.7%. In some studies, such as the one by Rodríguez-Adrián et al. [12], they report that at least 87% of patients with ocular involvement had at least one condition other than fungemia that could explain the fundus findings, such as diabetes, HIV infection, hypertension and leukaemia. It is interesting to clarify that although in our study the majority of patients with ocular involvement had positive cultures for C. albicans, it did not represent a statistically significant risk. Similarly, our study found that only six patients had clear chorioretinitis and one of them endophthalmitis, which corresponds to 31% of patients with ocular involvement, whereas the other 69% represents non-specific findings that may be due to the previously described conditions also presented in our population. This means that excluding non-specific findings, the incidence of posterior pole involvement for our population is 7.21%.
Culture-Proven Candida Albicans Endogenous Endophthalmitis in a Patient with Onychomycosis
Published in Ocular Immunology and Inflammation, 2020
Yağmur Seda Yeşiltaş, Gökçen Özcan, Sibel Demirel, Nilüfer Yalçındağ
Treatment with systemic agents is usually adequate for chorioretinitis. Macula threatening chorioretinitis and endophthalmitis additionally require intravitreal antifungal injections of amphotericin or voriconazole.11 As azoles are less toxic and produce higher penetration to vitreous fluconazole and voriconazole for fluconazole-resistant candidas are preferred to amphotericin. We could provide fluconazole to the patient at the 5th day of treatment and added it to the treatment of amphotericin. Echinocandins reach acceptable levels in choroid but there are a few humans’ data for threating chorioretinitis. It cannot reach an adequate concentration in vitreous and should not be the choice for endophthalmitis. Early vitrectomy is recommended for significant vitritis and lesions threatening the macular region. Early vitrectomy for yeast endophthalmitis also lowers the incidence of retinal detachment caused by infection.12