1/14. Neurosarcoidosis diagnosed during pregnancy by thoracoscopic lymph node biopsy. A case report.BACKGROUND: sarcoidosis is a multiorgan-system granulomatous disease causing respiratory complaints in most patients. eye involvement, most commonly granulomatous uveitis, is seen in 5% of black patients with sarcoidosis. Neurosarcoidosis is also rare, affecting 5% of patients with sarcoidosis. Thoracoscopic lymph node biopsy in pregnancy has never before been reported. CASE: An otherwise-healthy, 25-year-old woman, gravida 2, para 1001, presented at 25 weeks' gestation with a painful facial palsy and visual defects. Ophthalmologic examination revealed uveitis, and a chest radiograph revealed asymmetric hilar adenopathy. At 28 weeks' gestation, the patient underwent thoracoscopic lymph node biopsy, which confirmed the diagnosis of sarcoidosis. The symptoms were stabilized with therapeutic corticosteroids, and the patient delivered a healthy neonate at term. CONCLUSION: The diagnosis of sarcoidosis remains one of exclusion and requires a high index of suspicion. Tissue confirmation is often necessary, especially when patients have extrathoracic complaints. For patients without other lesions amenable to biopsy, thoracoscopic lymph node biopsy can be considered despite pregnancy.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
2/14. Infliximab-responsive uveitis and vasculitis in a patient with takayasu arteritis.uveitis rarely occurs in patients with takayasu arteritis (TA) and may be the presenting manifestation in some. We present the case of a 22-year-old black woman who presented with bilateral uveitis. She was subsequently diagnosed with TA and treated with high doses of corticosteroids and methotrexate. However, she experienced recurrent episodes of uveitis and arteritis on this regimen. Addition of infliximab resulted in resolution of both uveitis and arteritis, thereby permitting tapering of steroids and discontinuation of methotrexate over a period of 1 year. The case highlights the importance of keeping TA in the differential in patients with uveitis and considering infliximab in resistant uveitis and patients with TA.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
3/14. Vogt-Koyanagi-Harada syndrome and pregnancy.Two black women had bilateral anterior and posterior uveitis, nonrhegmatogenous retinal detachments, pleocytosis, headaches, dysacousis, and alopecia. These patients with Vogt-Koyanagi-Harada (VKH) syndrome improved clinically while they were pregnant after the discontinuation of corticosteroid treatment. They developed recurrent symptoms and findings after termination of their pregnancies. We speculate that changes in immunity and humoral constituents during pregnancy account for their remissions. It is important to assess the menstrual history and to avoid pregnancy before initiating steroid treatment for VKH syndrome.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
4/14. sarcoidosis and peripheral neovascularization.Twenty-eight patients with sarcoidosis were examined. Four of the patients had a history of uveitis. Retinal periphlebitis was noted in one case, and peripheral retinal neovascularization was found in two non-sickle cell black patients. vitreous hemorrhage developed in one of the patients with neovascularization, prior to laser treatment and this patient eventually required vitreous surgery. The other patient was treated with prophylactic laser. Peripheral retinal neovascularization may be a noteworthy finding that will be found in larger numbers with attention to the retinal periphery in cases of sarcoidosis.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
5/14. Reiter's syndrome in an adolescent female with systemic sequelae.Reiter's syndrome (RS) generally affects adult white males. It occurs infrequently in adolescents. This condition is characterized by a triad of symptoms: arthritis, urethritis, and ocular abnormalities, and it usually has a benign course. We report an atypical case of RS in a black adolescent female who developed articular and ocular sequelae. Despite aggressive medical therapy, one year after diagnosis her condition has deteriorated and she is confined to a wheelchair. Although RS is believed to be a brief illness predominantly affecting the joints of the lower extremity, this condition may have severe systemic manifestations with chronic sequelae.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
6/14. Overlap of granulomatous vasculitis and sarcoidosis: presentation with uveitis, eosinophilia, leg ulcers, sinusitis, and past foot drop.A 24-year-old black woman with a history of pulmonary and hepatic sarcoidosis followed by foot drop presented with uveitis, eosinophilia, leg ulcers, and sinus opacification. biopsy of the leg ulcer and review of the past lung biopsy revealed numerous epithelioid noncaseating granulomas and granulomatous vasculitis. Although her clinical presentation raised the possibility of Wegener's granulomatosis, the many discrete granulomas and lack of necrosis on her biopsies were more in favor of sarcoidosis. Although granulomatous vasculitis has been reported as part of necrotizing sarcoid granulomatosis, our patient was unique in the extent and type of her extrapulmonary symptomatology.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
7/14. Vogt-Koyanagi-Harada's disease in brazil.A retrospective analysis of 33 patients with Vogt-Koyanagi-Harada disease (VKH disease) seen in Sao Paulo, brazil, from 1976 to 1985 at a uveitis referral clinic revealed that VKH disease represents 2.5% of the total uveitis cases seen. All cases were bilateral, 30% being men and 70% women. The ethnic distribution was the following: 60% white (with variable Indian or black extraction), 24% darkly pigmented, 9% Orientals (Sansei, third-generation Japanese) and 6% black. The frequency among Orientals was 7 times higher than what would be expected according to the relative frequency of Japanese in the Brazilian population. The age distribution at the onset of the disease was as follows: 12% less than 20 years of age, 60% between 20 and 40 years of age and 27% over 40 years of age. The disease was classified into 3 types with variable extraocular signs. Type I disease was present in 24% of the patients, type II in 51% and type III disease in 24% of the patients. cataract was present in 40% of the cases and glaucoma was present in 9%. No correlation was found between sex, age at onset, race, type of extraocular involvement and number of extraocular manifestations in considering either visual status or visual prognosis. All patients were treated with systemic steroids. Most of them also received cytotoxic immunosuppressive agents. In this uncontrolled clinical study cytotoxic drug-treated patients seemed to have a better clinical course.- - - - - - - - - - ranking = 2keywords = black (Clic here for more details about this article) |
8/14. Acute orbital pseudotumor with iatrogenic intraorbital air: a diagnostic dilemma.A 13-year-old black female was referred with unilateral granulomatous uveitis and orbital inflammation of sudden onset. Hematologic, serologic, bacteriologic, and ultrasonographic studies along with high resolution CT scans of the orbits were employed to determine the diagnosis and appropriate treatment. Subconjunctival corticosteroid injection containing air prior to referral obfuscated the ultimate diagnosis of pseudotumor. The Pediatric Infectious disease service delayed definitive treatment with systemic steroids. Differential diagnosis of granulomatous uveitis with orbital inflammation are discussed. CT scan has significantly advanced the diagnosis and management of orbital pseudotumor.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
9/14. confusion of a poststreptococcal syndrome complicated by uveitis with mucocutaneous lymph node syndrome.This article describes the case of a 13-year-old black male who fulfilled the diagnostic criteria for mucocutaneous lymph node syndrome (MLNS), but developed severe posterior uveitis. Because severe posterior uveitis is not reported in MLNS, the patient's diagnostic evaluation was repeated and a markedly elevated antistreptolysin O titer detected. Since severe posterior uveitis is known to complicate streptococcal infection, we concluded this was the more likely etiology of the child's illness. This was an important differentiation, because prednisone therapy was felt to be indicated for the uveitis but is contraindicated in MLNS. This case also highlights the importance of careful and sometimes repeated diagnostic evaluation before the description of a previously unreported manifestation of a disease for which no single diagnostic test exists. If the diagnostic workup had not been repeated, this child would have been reported as having severe posterior uveitis complicating MLNS.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
10/14. Peripapillary subretinal neovascularization in chronic uveitis.Peripapillary subretinal neovascularization progressively developed in both eyes of a 17-year-old black woman with bilateral chronic granulomatous uveitis. Despite intensive medical therapy, central vision was lost in the left eye due to disciform scarring that extended to the macula. When a similar process was discovered in the right eye, argon laser therapy was started and was successful in eliminating all areas of subretinal neovascularization in the right eye while maintaining good cental vision. Chronic uveitis is probably another cause of peripapillary subretinal neovascularization, which can be treated with photocoagulation in spite of the presence of inflammation.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
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