[Bilateral uveitis in relapsing polychondritis. A case report]

We report a rare ocular manifestation of relapsing polychondritis. A 28-year-old woman presented with a 5-year history of relapsing polychondritis with chondritis of the nose, ears and tracheobronchial system. The ocular symptoms were bilateral uveitis with macular involvement and papillaedema. Ocular manifestations of relapsing polychondritis occur in 60% of patients. Uveitis is a rare symptom, sometimes severe, which can lead to blindness. This case report with a literature review sheds light on the features of this disease.

Leucémie aiguë lymphoblastique T/Lymphome lymphoblastique orbitaire chez l’enfant

CASE

The authors report a case of an 6-year-old pediatric patient with a history of acute onset of proptosis of his right eye. He was admitted at hospital 6 months ago for proptosis concomitant with orbital trauma. Computed tomography scan demonstrated a mass involving the right orbit, right maxillary sinus, and zygoma with endocranial extension.

RESULTS

Incisional biopsy of the mass revealed after of histopathologic and immuno-histochemical evaluation a T-cell lymphoblastic lymphoma. Systemic examination and bone marrow aspirate show a acute lymphoblastic leukemia. The patient was treated with LMT96 Protocol. A complete Remission was observed after 13 months of follow up.

CONCLUSION

Primary T-cell lymphoblastic lymphoma of the orbit is a rare entity in any age group, but it is very rare in children. When tumors occurs in the orbit, it presents a challenging diagnosis problem, especially in pediatric patients.

[Hyphema with secondary hemorrhage: think about sickle cell disease]

The Authors report a case of a 13-Year-old white child who presented a grade I hyphema, anterior chamber inflammation after trauma. He presented a secondary hemorrhage with increased intraocular pressure that was not controlled within 48 h, thus requiring surgical intervention. A hemoglobin electrophoresis and hemostasis test showed a sickle cell trait. After hemorrhage resorption, the ocular fundus showed substantial retinal hemorrhage. The final visual outcome was poor and attributed to optic atrophy. Sickle cell trait is a significant risk factor for secondary hemorrhage, increased intraocular pressure, and permanent visual impairement in children who have traumatic hyphemas following blunt trauma.

Persistance et hyperplasie du vitré primitif et syndrome d’Aicardi

INTRODUCTION

Aicardi syndrome is characterized by infantile spasms, agenesis of the corpus callosum and chorioretinal lacunae. This disorder affects mostly females, with early embryonic lethality in males. Numerous general and ocular disorders may be associated with this affection. We present here a case of persistent hyperplastic primary vitreous (PHPV) in association with Aicardi syndrome in a 30-year-old woman.

CASE REPORT

The authors report a case of a 30-year-old woman with Aicardi syndrome associated with persistent hyperplastic primary vitreous.

DISCUSSION

Aicardi syndrome is a polymalformative disease occurring at an early period of embryogenesis. It can affect many ocular structures. This syndrome is essentially described in female children, who rarely reach an adult age. The observation we report is particular because of the patient's age (30-years-old) and the association with a persistent hyperplastic primary vitreous, exceptional in this context.

CONCLUSION

With a review of the literature, the Authors discuss the clinical neuroradiological and prognostic aspects of this polymalformative syndrome and different associated general and ocular abnormalities, emphasizing particularly those of persistent hyperplastic primary vitreous in this affection.

Aniridie congénitale bilatérale familiale : à propos de 5 cas

INTRODUCTION

Aniridia is a rare familial or sporadic disorder affecting not only the iris but also the cornea, angle structures, lens, optic nerve, and fovea. This disorder may be associated with many other systemic abnormalities such as urogenital malignancies.

CASE REPORTS

A 44-Year-old man who complained of visual loss presented bilateral congenital aniridia with corneal dystrophy and dense cataract. His 12-Year-old daughter also presented visual loss with severe bilateral corneal dystrophy and total congenital cataract associated with aniridia. Two other daughters, 18 and 23 Years of age, and an 11-Year-old son had nystagmus with bilateral congenital cataract and ectopia lentis. Clinical and radiological investigations did not disclose evidence of extraocular abnormalities in this family. Three patients underwent cataract extraction without intraocular implantation and the aphakia was corrected with glasses. All three patients progressed well.

DISCUSSION

This family provided a good illustration of the different clinical spectra of ocular involvement in congenital aniridia and its management difficulties, above all those of cataract surgery and correction of aphakia.

CONCLUSION

Aniridia is a genetic disease with possible association with other ocular and systemic disorders, which may compromise visual and vital prognosis. Genetic advice is very important in such families.

[Extensive peripapillary myelinated nerve fibers, high ipsilateral myopia and refractory amblyopia]

INTRODUCTION

Extensive peripapillary myelinated nerve fibers can be associated with myopic anisometropia amblyopia. Despite aggressive occlusion of the good eye, visual results are often disappointing, probably because of structural anomalies of the macula, limiting visual potential.

OBSERVATION

The authors report the case of a 5-year-old girl presenting extensive peripapillary myelinated nerve fibers associated with myopic anisometropia. Amblyopia did not respond to optical correction and continuous occlusion of the good eye for 9 weeks.

DISCUSSION

Certain authors report obtaining good results with aggressive treatment of amblyopia associated with extensive peripapillary myelinated nerve fibers and myopic anisometropia. However, the majority of the few series published in the literature report that amblyopia related to this pathology is particularly refractory to treatment, as confirmed by the case study presented herein.

CONCLUSION

Despite a certain number of cases with a good prognosis reported in associated peripapillary myelinated nerve fibers and ipsilateral myopia, we believe that its visual prognosis remains reserved and that patients and/or their families should be provided with appropriate information.

Sclérite postérieure simulant une épithéliopathie en plaques

INTRODUCTION

Posterior scleritis is a rare but probably underdiagnosed process. The lesions may cause diagnostic confusion with other diseases such as intraocular tumors and orbital or cerebral involvement. In the case presented, posterior scleritis simulated acute posterior multifocal placoid pigment epitheliopathy.

CASE REPORT

A 43-year-old woman presented with a history of pain and eye redness with lid swelling in the left eye followed by visual deterioration. On fundus examination, there was disc and macular edema with multiple grayish-white placoid and deep chorioretinal lesions in the posterior pole. Fluorescein angiography was compatible with acute posterior multifocal placoid pigment epitheliopathy, but the inflammatory context was unusual in this disorder. An orbital computed tomographic scan and b-scan ultrasonography showed posterior scleral thickening and the diagnosis of posterior scleritis was made. Etiological investigations were negative. A pulse of corticosteroids was started and the patient's symptoms and signs improved on clinical and angiographic examination.

DISCUSSION

Posterior scleritis may present with a range of clinical findings. Its clinical features may simulate many other diagnoses such as acute posterior multifocal placoid pigment epitheliopathy. Management is different in each situation: abstention in acute posterior multifocal placoid pigment epitheliopathy and a high dose of corticosteroids or even immunosuppressive therapy in posterior scleritis.

CONCLUSION

This report shows that posterior scleritis must be evoked in patients with unilateral fundus appearance of acute posterior multifocal placoid pigment epitheliopathy associated with an inflammatory context. Ultrasonography or MRI must be carried out.

[Uveitis in children: about 20 cases]

INTRODUCTION

Uveitis in children is rare: 3%-8% of all cases. It requires the same diagnostic and etiological processes as uveitis in adults, with additional difficulties at examination and a sometimes insidious progression.

MATERIAL AND METHODS

Retrospective study of 20 cases of childhood uveitis from 1995 to 2000. All patients received an ophthalmologic examination and an etiological search, with specific and/or symptomatic treatment and follow-up lasting from 6 months to 5 years.

RESULTS

The 20 children presenting uveitis were 4-16 years old, with etiologies as follows: 8 cases of Behçet's disease, 2 cases of Vogt-Koyanagi-Harada's disease, 1 case of sarcoidosis, 1 case of uveitis associated with coeliac disease, 1 case of toxoplasmosis, 1 case of sympathetic ophthalmia, 1 case of uveitis with streptococcal infection, 3 cases of ocular toxocarosis, and 2 cases with unknown etiology. Treatment based on the etiological findings was started in the cases of toxoplasmosis and uveitis from streptococcal infection. The others were treated with high- and then digressive-doses of corticosteroids.

ANALYSIS

We have noted the high incidence of Behçet's disease in our series. Progression was marked by frequent recurrence for one case of Vogt-Koyanagi-Harada's syndrome and one case of toxoplasmosis. This study also revealed a few cases of complicated cataract.

DISCUSSION

Clinical characteristics, diagnosis, and treatment of uveitis in children are discussed.

[Choroidal granuloma revealing tuberculosis. A case report]

BACKGROUND

The incidence of tuberculosis is still high in developing countries and a steady increase in new cases has been observed in industrial countries within the past decade. Among other reasons, the growing number of immunodeficient patients and migration from developing to industrial countries are both contributing factors.

OBSERVATION

A 70-year-old female patient presented with a marked decrease in visual acuity of the left eye. There was no history of tuberculosis. Funduscopy of the left eye revealed a choroidal tumor with multiple choroidal lesions, mostly located at the posterior pole, and adjacent serous retinal detachment. Ultrasonography showed a solid elevated mass; magnetic resonance imaging showed the tumor with posterior extension. Because of blindness in this eye and the presence of posterior extension, the eye was subsequently enucleated. Intraoperative observation found caseum necrosis through scleral breaking. The histological study confirmed choroidal tuberculoma. The patient developed pulmonary tuberculosis 15 days after surgery. The outcome was favorable after antibiotic treatment.

DISCUSSION

Confirming the diagnosis of tuberculous uveitis is often difficult. The differential diagnosis includes other granulomatous ocular inflammations. The detection of Mycobacterium tuberculosis and the clinical course make this diagnosis the most likely one.

CONCLUSION

Choroidal granuloma is a rare and atypical location of tuberculosis. This case showed the diagnostic difficulties when there is no history of tuberculosis.

[Childhood Behçet's disease: clinical and evolutive aspects. About 13 cases]

INTRODUCTION

Behçet's disease is a systemic vasculitis which rarely occurs in childhood. The aim of this study was to evaluate clinical characteristics and outcome of Behçet's disease in Moroccan children.

MATERIAL AND METHODS

A retrospective study of 13 cases of children, 10 males and 3 females with Behçet's disease followed up between 1990 and 1998. The diagnosis of Behçet's disease was based on the criteria of the international study group for Behçet's disease. All patients were studied by a complete clinical, ophthalmological and laboratory staging and treated with appropriate therapy.

RESULTS

The mean age at diagnosis of Behçet's disease was 13.9 years. Familial forms were found in 30.7% of cases. Oral aphtae were noted in all cases while genital ulcers were present in 76% of cases. Cutaneous lesions were found in only 1 case and 53.8% of children had a pathergy test. Articular involvement was found in 30.7%, neurological features in 46% and vascular manifestations in 38.4%. Only one case of intestinal involvement was noted. Ocular features (76%) were bilateral in all cases and were dominated by panuveitis complicated by macular edema ant retinal vasculitis.

CONCLUSION

Behçet's disease seems to have particular characteristics in childhood. Familial forms, articular and digestive manifestations appear to be more frequent in early stages of Behçet's disease in children. Neurological and vascular involvement with panuveitis seems more frequent in the older children.

[Vogt-Koyanagi-Harada syndrome in children]

INTRODUCTION

Uveitis in children accounts for 5% to 10% of all uveitis cases. Some causes such as Vogt-Koyanagi-Harada syndrome rarely affect young children. We report two cases.

CASE REPORT

No.1: A 9-year-old girl was followed up for severe and chronic total uveitis. General fundus depigmentation with several white and yellowish rounded lesions in peripheral fundus suggested the diagnosis of Vogt-Koyanagi-Harada, which was confirmed by the development of areas of vitiligo in the lumbar region. The patient was treated with a bolus of corticosteroid therapy. No. 2: A 12-year-old girl had bilateral uveopapillitis and the clinical initial examination and laboratory evaluation failed to provide a diagnosis. The patient was also treated with a bolus of corticosteroid therapy and then high-dose oral prednisone. After several months, the patient's examination showed a sunset glow fundus with several white and yellowish rounded lesions in peripheral fundus.

DISCUSSION

Vogt-Koyanagi-Harada syndrome rarely affects young children, so the diagnosis may be difficult if the extraocular manifestations are not present. The bolus of corticosteroid therapy and cytotoxic agents may be necessary and the prognosis may be poor in severe cases.

[Colobomatous orbital cyst associated with microphthalmos. Apropos of a case]

Colobomatous orbital cyst with microphthalmos is a rare anomaly occurring during embryogenesis. The authors describe a case of colobomatous orbital cyst with microphthalmos in a three-month-old child underlying the difficulties of clinical diagnosis and emphasizing the role of radiologic investigations. It is only the histopathologic study which allows the final diagnosis. From the informations given by this observation, the authors discuss the pathogenic, diagnostic, histopathologic and therapeutic characteristics of this disease.

Contribution de la biopsie stereotaxique dans la prise en charge des tumeurs cerebrales: a propos de 283 cas

Introduction L’avènement de la biopsie stéréotaxique (BST) et le développement du scanner et de l’IRM ont amélioré la prise en charge des tumeurs cérébrales. Le but de cette étude est d’évaluer le rôle de la BST dans la prise en charge des tumeurs cérébrales. Matériel et Méthodes Etude rétrospective de 1995 à 2008 concernant 283 patients consécutifs ayant des tumeurs cérébrales, ayant bénéficié d’une BST, colligés au service de Neurochirurgie. L’âge moyen était de 45.5 ans (9 à 84). La BST fut réalisée sous guidage scannographique dans 260 cas et sous guidage IRM dans 23 cas. Pour les tumeurs pinéales, depuis Janvier 2000, une artériographie avec temps phlébographique et IRM préopératoire ont été jugées utiles pour éviter les complications hémorragiques. Resultats Dans 271 cas, la BST était concluante dès la première tentative (95.7%). La répétition de la BST a permis de rétablir un diagnostic précis. Il s’agissait de lésions malignes (70 % des cas). La mortalité péri-opératoire est passé de 5,9% avant 2000 à 0% après 2000 (Chi-carré; p = 0,013). Conclusion Les BST doivent être étagées et répétées en cas d’histologie non concluante. Pour les petites lésions profondes la BST en conditions IRM est nécessaire. Pour les tumeurs pinéales, elle doit être réalisée par voie orthogonale trans-temporale.Mots-clés: Biopsie stéréotaxique, tumeur cérébrale, pinéal

Les kystes dermoïdes de la fosse cerebrale postereure

Matériel et Méthode 3 enfants âgés de 18 mois à 8 ans ont été colligés au service entre 2005 et 2010. Résultas 3 patients ont présenté un syndrome d’hypertension intracrânienne, dont un patient a présenté une méningite récidivante. Tous avaient un sinus dermique. L’IRM a été réalisée dans tous les cas. Tous ont bénéficié d’une exérèse chirurgicale totale et d’une dérivation du LCR par ventriculo-cisternostomie première en urgence dans un cas et par dérivation ventriculo-péritonéale en post-opératoire dans deux cas. L’évolution était satisfaisante sans récidive avec un recul moyen de 3 ans. Conclusion Dans notre série, le KD de la fosse cérébrale postérieure est toujours associé à un sinus dermique et à une hydrocéphalie. La prise en charge repose sur l’exérèse chirurgicale et sur la dérivation du liquide cérébro-spinal.Mots clés : kyste dermoïde, sinus dermique, fosse cérébrale postérieure, chirurgie, résonance magnétique