1/20. Rhino-orbital mucormycosis in a patient with acquired immunodeficiency syndrome (AIDS) and neutropenia.PURPOSE: To present a case of rhino-orbital mucormycosis in a patient with AIDS and neutropenia managed without exenteration. methods: Case report. RESULTS: A 60-year-old African-American man with AIDS developed neutropenia that was probably secondary to antiretroviral therapy. He developed right rhino-orbital mucormycosis and was treated with right partial ethmoidectomy with debridement and liposomal amphotericin b. The infection was cured without need for orbital exenteration, although visual acuity in his right eye ultimately was no light perception. CONCLUSION: Rhino-orbital mucormycosis is uncommon in patients with AIDS. When rhino-orbital mucormycosis occurs, patients require a careful search for an underlying metabolic derangement such as neutropenia. Treatment should be aggressive, but these patients may not require orbital exenteration.- - - - - - - - - - ranking = 1keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
2/20. Ocular and central nervous system paracoccidioidomycosis in a pregnant woman with acquired immunodeficiency syndrome.PURPOSE: To describe an atypical case of central nervous system and ocular paracoccidioidomycoses simulating ocular toxoplasmosis in a pregnant woman with acquired immunodeficiency syndrome (AIDS). DESIGN: Interventional case report. methods: Case report. RESULTS: A 25-year-old pregnant woman with AIDS, presented with a severe ocular inflammation in the right eye involving the choroid, retina, and the optic disk, which rapidly progressed to retinal detachment, iris neovascularization, and neovascular glaucoma. The left eye was normal. magnetic resonance imaging (MRI) showed a focal hypodense contrast-enhanced ring lesion in the brain. serum antibody titers were negative for toxoplasma gondii, but the polymerase chain reaction was positive for the parasite in the vitreous sample. The patient responded partially to specific treatment for toxoplasmosis, and there was a small reduction in size of the brain lesion. She progressed to a blind painful eye, which was enucleated. paracoccidioides brasiliensis was found in the histopathological studies of the eye and oropharynx. With the diagnosis of disseminated ocular paracoccidioidomycoses, the patient was treated with trimethoprim-sulfamethoxazole with a satisfactory outcome and reduction in size of the brain lesion. CONCLUSION: Although ocular infection with ocular paracoccidioidomycoses is rare, this diagnosis should be considered when investigating ocular inflammation in a patient with AIDS.- - - - - - - - - - ranking = 1.25keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
3/20. Histological examination of an eye with endogenous Aspergillus endophthalmitis treated with oral voriconazole: a case report.PURPOSE: To report the histological findings of an eye with severe Aspergillus endophthalmitis after oral treatment with voriconazole. methods. Case report. RESULTS: Histopathological examination revealed no fungal elements in choroidal or retinal vessels. The hyphae were mainly restricted to the vitreal side of the preretinal inflammatory infiltrate. Since the treatment with voriconazole had not been completed at the time of enucleation, the clinical course with potential further limitation or regression of the lesion remains unsettled. CONCLUSIONS: Endogenous Aspergillus endophthalmitis is a devastating condition often associated with immunodeficiency. The pathogenesis of this entity implies the primary invasion of choroidal and retinal vessels. The lack of antifungal drugs with high blood-ocular permeability results in an extremely poor visual prognosis. Our histological examination indicates promising activity and ocular penetration of the new antifungal agent voriconazole.- - - - - - - - - - ranking = 0.020508974726544keywords = immunodeficiency (Clic here for more details about this article) |
4/20. Post-LASIK infectious crystalline keratopathy caused by alternaria.PURPOSE: To describe a case of infectious crystalline keratopathy (ICK) after laser in situ keratomileusis (LASIK) caused by alternaria species. methods: A case report of a 29-year-old woman who presented with clinical features of ICK 3 weeks after LASIK surgery. RESULTS: Medical therapy failed to control and resolve the corneal infection. Penetrating keratoplasty was performed, which controlled the infection and aided in visual recovery of 20/30.The culture of the corneal button revealed the presence of alternaria species fungus. CONCLUSIONS: alternaria species fungus may cause ICK after LASIK.- - - - - - - - - - ranking = 0.0028001545425587keywords = aid (Clic here for more details about this article) |
5/20. Discontinuation of highly active antiretroviral therapy leads to cryptococcal meningitis/choroiditis in an AIDS patient.BACKGROUND: cryptococcus neoformans is an opportunistic pathogen that can manifest in immunocompromised patients with acquired immune deficiency syndrome. Prevention of cryptococcosis and other opportunistic diseases is an objective in the management of human immunodeficiency virus (hiv)-infected patients. The goal of highly active antiretroviral therapy (HAART) is to reduce the viral loads and enhance CD4 counts in hiv-infected patients. These 2 mechanisms keep hiv-infected patients healthier and enhance their immune systems, thus reducing and often preventing opportunistic infections such as ocular cryptococcal infections. Discontinuation of HAART can lead to ocular opportunistic infections such as cryptococcal choroiditis. CASE REPORT: Presented here is a case of a patient who was treated successfully with HAART of stavudine (D4T), abacavir (Ziagen), ritonavir (Norvir), and saquinavir (Invirase). His last CD4 count before HAART was discontinued was 131 cells/mm(3), and viral load was less than 50 copies/mL. He discontinued his HAART regimen for 2 years and presented to the emergency room with complaints of a severe headache with neck pain, lightheadedness, nausea, disorientation, and unsteady gait. Lumbar puncture results showed cryptococcal infection, and the patient was admitted for the treatment of cryptococcal meningitis with amphotericin b and 5-flucytosine. Cryptococcal choroiditis was diagnosed after treatment of the meningitis. After resolution, his resultant visual acuities were 10/350 in the right eye and 10/600 in the left eye. He is on a maintenance dose of antifungal therapy and has been reinitiated on HAART of abacavir/zidovudine/lamivudine (Trizivir) and lopinavir/ritonavir (Kaletra). CONCLUSION: This case exemplifies the importance of HAART in the prevention of opportunistic infections, cryptococcal meningitis/choroiditis in particular. eye care professionals can play a role in encouraging patients to comply with their HAART regimens.- - - - - - - - - - ranking = 0.020508974726544keywords = immunodeficiency (Clic here for more details about this article) |
6/20. Intraorbital injection of amphotericin b for palliative treatment of Aspergillus orbital abscess.We report successful palliative treatment of an aspergillus fumigatus orbital mass in a patient with acquired immunodeficiency syndrome by direct injection of amphotericin b into the abscess cavity. This case presents intraorbital injection of amphotericin b as an alternative to surgical debridement of Aspergillus orbital infection. In patients who are unable or unwilling to undergo more aggressive treatment, this procedure appears to limit morbidity while still providing effective palliative therapy.- - - - - - - - - - ranking = 0.25keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
7/20. Limbal and choroidal Cryptococcus infection in the acquired immunodeficiency syndrome.PURPOSE: A 30-year-old patient with the acquired immunodeficiency syndrome (AIDS) had limbal nodules and multifocal choroidal lesions. methods: A biopsy of the limbal nodules was performed. RESULTS: The biopsy showed cryptococcus neoformans surrounded by thick mucinous capsules without inflammatory cell infiltration. CONCLUSION: In the differential diagnosis of limbal mass in patients with AIDS, cryptococcal infection should be considered.- - - - - - - - - - ranking = 1.25keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
8/20. Involvement of anterior chamber angle structures in disseminated histoplasmosis: report of three cases.This study describes the involvement of anterior chamber (AC) angle structures in patients with disseminated histoplasmosis. The postmortem eyes from three patients (aged 33, 41, and 42 years, respectively) with disseminated histoplasmosis, two of whom had acquired immunodeficiency syndrome, were examined by light microscopy using hematoxylin-eosin, periodic acid-Schiff (PAS), and Gomori's methenamide silver (GMS) stains. Electron microscopy studies of the choroid were performed in one eye. Significant numbers of budding yeast forms of histoplasma capsulatum measuring 2-5 microns in diameter were observed within the trabecular meshwork, Schlemm's canal and in the deep intrascleral plexuses. All eyes showed massive involvement of the choroidal vasculature, including the choriocapillaris. The organisms were observed freely as well as in small clusters within the cytoplasm of circulating monocytes. The vessels of the limbal conjunctiva (two eyes) and ciliary body (three eyes) contained many histoplasma organisms. In one eye, several budding yeast were noted in an iris vessel and in occasional histiocytes within the ciliary muscle. blood smears containing histoplasma organisms were observed in two cases. None of the patients had an ophthalmologic examination prior to death. Involvement of the intravascular structures of the eye as well as the AC angle was observed in three patients with disseminated histoplasmosis. The fungus most likely reached the AC angle structures by direct hematogenous dissemination or via the aqueous humor by migration from vessels in the ciliary body and iris. An abnormal retrograde blood flow into the AC angle structures may have also played an important role. We suggested that the intraocular pressure be monitored in cases of suspected disseminated histoplasmosis to detect functional alterations indicative of a blockage in the outflow channels.- - - - - - - - - - ranking = 0.25keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
9/20. Endogenous Aspergillus endophthalmitis after lung transplantation.PURPOSE/methods: By fundus photography and histopathologic examination, we documented a case of early endogenous Aspergillus endophthalmitis in a 29-year-old man after lung transplantation. RESULTS/CONCLUSIONS: The clinical and histopathologic features of this case are consistent with those of previous case reports of endogenous Aspergillus endophthalmitis. Endogenous Aspergillus endophthalmitis represents a manifestation of disseminated aspergillosis, usually a fatal infection. This diagnosis should be considered in immunocompromised patients with visual disturbances, as early recognition of the fundus appearance may aid in systemic treatment.- - - - - - - - - - ranking = 0.0028001545425587keywords = aid (Clic here for more details about this article) |
10/20. optic nerve sheath decompression for visual loss in patients with acquired immunodeficiency syndrome and cryptococcal meningitis with papilledema.Visual dysfunction developing in association with acquired immunodeficiency syndrome (AIDS) can be multifactorial. Two patients with this syndrome and cryptococcal meningitis had papilledema and visual loss. Both were treated by optic nerve sheath fenestration. One patient had bilateral nonsimultaneous optic nerve sheath fenestrations; visual function improved in one eye. The other patient had bilateral visual improvement after a unilateral optic nerve sheath fenestration. Cryptococcal organisms were present in the dural sheath specimens of both patients despite ongoing therapy with antifungal medication. Postoperative orbital infectious complications did not occur. autopsy examination of one patient showed that the sites of fenestration were patent. Medical treatment of cryptococcal meningitis associated with AIDS has a guarded prognosis. optic nerve sheath fenestration offers a treatment alternative for papilledema and visual loss that occur with cryptococcal meningitis.- - - - - - - - - - ranking = 1.25keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
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