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Zhao H, Peng X. Tuberculin Skin Testing Induces Bilateral Tuberculous Uveitis in a Junior High School Student. Ocul Immunol Inflamm 2022; 30:160-162. [PMID: 32783680 DOI: 10.1080/09273948.2020.1778731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report a rare case of bilateral tuberculous uveitis associated with tuberculin skin testing (TST) in an otherwise healthy junior high school student. A 12-year-old boy presented with severely decreased vision in both eyes and a history of an intradermal PPD (purified protein derivative) skin test 12 days earlier. The best-corrected visual acuity (BCVA) was 20/1000 in both eyes (OU). Ocular examination showed multifocal grayish-yellow choroidal tubercles. Laboratory examinations, including T-SPOT.TB, revealed no abnormal findings. He was diagnosed with tuberculous uveitis. Combined corticosteriod and anti-tuberculosis therapy (ATT) was given. The BCVA improved to 20/25, and the choroidal tubercles faded away. Our case suggests that TST may induce bilateral uveitis in rare cases.
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Affiliation(s)
- Huiying Zhao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing, China.,Department of Ophthalmology, Beijing Geriatric Hospital, Beijing, China
| | - Xiaoyan Peng
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing, China
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Naidu SC, Kaplan AJ, Daneman N, Sundaram ANE, Kohly RP. Abnormal skin changes and unilateral vision loss after a tuberculin skin test. CMAJ 2021; 193:E1811-E1814. [PMID: 34844939 PMCID: PMC8654895 DOI: 10.1503/cmaj.211021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sumana C Naidu
- Temerty Faculty of Medicine (Naidu); Department of Ophthalmology and Vision Sciences (Kaplan, Sundaram, Kohly), University of Toronto; Kensington Eye Institute (Kaplan); Department of Medicine, Division of Infectious Diseases (Daneman), and of Medicine, Division of Neurology (Sundaram), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Alexander J Kaplan
- Temerty Faculty of Medicine (Naidu); Department of Ophthalmology and Vision Sciences (Kaplan, Sundaram, Kohly), University of Toronto; Kensington Eye Institute (Kaplan); Department of Medicine, Division of Infectious Diseases (Daneman), and of Medicine, Division of Neurology (Sundaram), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Nick Daneman
- Temerty Faculty of Medicine (Naidu); Department of Ophthalmology and Vision Sciences (Kaplan, Sundaram, Kohly), University of Toronto; Kensington Eye Institute (Kaplan); Department of Medicine, Division of Infectious Diseases (Daneman), and of Medicine, Division of Neurology (Sundaram), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Arun N E Sundaram
- Temerty Faculty of Medicine (Naidu); Department of Ophthalmology and Vision Sciences (Kaplan, Sundaram, Kohly), University of Toronto; Kensington Eye Institute (Kaplan); Department of Medicine, Division of Infectious Diseases (Daneman), and of Medicine, Division of Neurology (Sundaram), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Radha P Kohly
- Temerty Faculty of Medicine (Naidu); Department of Ophthalmology and Vision Sciences (Kaplan, Sundaram, Kohly), University of Toronto; Kensington Eye Institute (Kaplan); Department of Medicine, Division of Infectious Diseases (Daneman), and of Medicine, Division of Neurology (Sundaram), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.
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Yakin M, Kesav N, Cheng SK, Caplash S, Gangaputra S, Sen HN. The Association between QuantiFERON-TB Gold Test and Clinical Manifestations of Uveitis in the United States. Am J Ophthalmol 2021; 230:181-187. [PMID: 33945821 DOI: 10.1016/j.ajo.2021.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/10/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To report the prevalence of QuantiFERON-TB Gold (QFT-G) positivity among uveitis patients compared to general population and to evaluate the differences in clinical features of uveitis. DESIGN Retrospective cohort study. METHODS SETTING: Institutional. PATIENT POPULATION 418 consecutive new uveitis patients, regardless of clinical suspicion, were tested for QFT-G. OBSERVATION PROCEDURES Demographics, TB risk factors, clinical characteristics of uveitis were collected. MAIN OUTCOME MEASURES The frequency of QFT-G positivity among uveitis patients and characteristic clinical features among QFT-G positive patients. RESULTS QFT-G positivity was found in 60/418 patients with uveitis (14.4%, 95% CI: 11.18 - 18.14) higher than the general US population (5%, 95% CI: 4.2 - 5.8, p<.001). Age, gender and residence were similar between QFT-G positive and negative groups. Uveitis patients with positive QFT-G were more likely to be foreign born or have a recent travel history (OR:5.84; 95% CI: 2.83 - 12.05; p<.001). QFT-G positive patients were more likely to present with granulomatous uveitis (OR 2.90; 95%CI 1.36 - 6.21; p=.006). No significant association was found with specific clinical features such as choroiditis, retinal vasculitis, occlusive vasculitis, and serpiginoid choroiditis (p>.05 for each). Prevalence of TB-uveitis based on treatment response was 1.19%. CONCLUSIONS Our study demonstrates significantly higher prevalence of QFT-G positivity among uveitis patients compared to average US population. Characteristic signs of TB uveitis reported in endemic countries were not seen in this cohort. Implications of higher prevalence of QFT-G positivity among uveitis patients require further investigation.
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Jain M, Vadboncoeur J, Garg SJ, Biswas J. Bacille calmette-guérin: An ophthalmic perspective. Surv Ophthalmol 2021; 67:307-320. [PMID: 34343536 PMCID: PMC8325561 DOI: 10.1016/j.survophthal.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 01/20/2023]
Abstract
Vaccines such as bacille Calmette-Guérin (BCG) are known for their heterologous effects mediated through a number of mechanisms, including trained immunity constituted by monocyte-macrophage based innate immunity. Other events such as direct hematogenous spread and induction of autoimmunity are also described. There has been a resurgent interest in harnessing some of the benefits of trained immunity in the management of COVID-19, even as several specific vaccines have been approved. We summarize the current knowledge of ocular effects of BCG. Potential effect of granulomatous inflammation on angiotensin converting enzyme activity and accentuation of cytokine storm that may result in undesirable ocular and systemic effects are also discussed.
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Affiliation(s)
- Manish Jain
- Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, UK, India
| | - Julie Vadboncoeur
- Department of Ophthalmology, Université de Montréal, Montréal, Uveitis Service, University Ophthalmology Center, Maisonneuve-Rosemont Hospital, Montréal, Canada
| | - Sunir J Garg
- Thomas Jefferson University, Philadelphia, PA USA
| | - Jyotirmay Biswas
- Director of Uveitis & Ocular Pathology Department, Sankara Nethralaya, Chennai, TN, India
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Maleki A, Anesi SD, Look-Why S, Manhapra A, Foster CS. Pediatric uveitis: A comprehensive review. Surv Ophthalmol 2021; 67:510-529. [PMID: 34181974 DOI: 10.1016/j.survophthal.2021.06.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
Pediatric uveitis accounts for 5-10% of all uveitis. Uveitis in children differs from adult uveitis in that it is commonly asymptomatic and can become chronic and cause damage to ocular structures. The diagnosis might be delayed for multiple reasons, including the preverbal age and difficulties in examining young children. Pediatric uveitis may be infectious or noninfectious in etiology. The etiology of noninfectious uveitis is presumed to be autoimmune or autoinflammatory. The most common causes of uveitis in this age group are idiopathic and juvenile idiopathic arthritis-associated uveitis. The stepladder approach for the treatment of pediatric uveitis is based on expert opinion and algorithms proposed by multidisciplinary panels. Uveitis morbidities in pediatric patients include cataract, glaucoma, and amblyopia. Pediatric patients with uveitis should be frequently examined until remission is achieved. Once in remission, the interval between follow-up visits can be extended; however, it is recommended that even after remission the child should be seen every 8-12 weeks depending on the history of uveitis and the medications used. Close follow up is also necessary as uveitis can flare up during immunomodulatory therapy. It is crucial to measure the impact of uveitis, its treatment, and its complications on the child and the child's family. Visual acuity can be considered as an acceptable criterion for assessing visual function. Additionally, the number of cells in the anterior chamber can be a measure of disease activity. We review different aspects of pediatric uveitis. We discuss the mechanisms of noninfectious uveitis, including autoimmune and autoinflammatory etiologies, and the risks of developing uveitis in children with systemic rheumatologic diseases. We address the risk factors for developing morbidities, the Standardization of Uveitis Nomenclature (SUN) criteria for timing and anatomical classifications, and describe a stepladder approach in the treatment of pediatric uveitis based on expert opinion and algorithms proposed by multi-disciplinary panels. In this review article, We describe the most common entities for each type of anatomical classification and complications of uveitis for the pediatric population. Additionally, we address monitoring of children with uveitis and evaluation of Quality of Life.
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Affiliation(s)
- Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Stephen D Anesi
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Sydney Look-Why
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Ambika Manhapra
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA; Harvard Medical School, Department of Ophthalmology, Boston, MA, USA.
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Benchekroun Z, Lamrani YA, Haloua M, Boubbou M, Maâroufi M, Alami B. Optic nerve tuberculoma in an immunocompetent patient: Case report. Radiol Case Rep 2021; 16:731-735. [PMID: 33510826 PMCID: PMC7815977 DOI: 10.1016/j.radcr.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/01/2021] [Accepted: 01/02/2021] [Indexed: 10/28/2022] Open
Abstract
Optic nerve tuberculoma is a rare extra-pulmonary manifestation of mycobacterial infection. It is usually associated with HIV infected patients. Due to its clinical polymorphism, the diagnosis and management of the disease either in immunocompetent patients and immunocompromised ones remains challenging. Herein, we discuss a case of a 32-year-old patient with no history of immunodeficiency admitted for multifocal tuberculosis with a reduced visual acuity as an extra-pulmonary manifestation, and radiologically revealed the presence of tuberculoma in the optic nerve in the cerebral MRI.
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Affiliation(s)
- Zineb Benchekroun
- Radiology Department of CHU HASSAN II de Fez, Fez, Morocco
- Faculty of Medecine Fez, Universitý Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Youssef Alaoui Lamrani
- Radiology Department of CHU HASSAN II de Fez, Fez, Morocco
- Faculty of Medecine Fez, Universitý Sidi Mohamed Ben Abdellah, Fez, Morocco
- Laboratoire de Neurosciences, Clinique Faculty of Medecine Fez, Universitý Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Meriem Haloua
- Radiology Department of CHU HASSAN II de Fez, Fez, Morocco
- Faculty of Medecine Fez, Universitý Sidi Mohamed Ben Abdellah, Fez, Morocco
- Laboratoire de Neurosciences, Clinique Faculty of Medecine Fez, Universitý Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Meriem Boubbou
- Radiology Department of CHU HASSAN II de Fez, Fez, Morocco
- Faculty of Medecine Fez, Universitý Sidi Mohamed Ben Abdellah, Fez, Morocco
- Laboratoire de Neurosciences, Clinique Faculty of Medecine Fez, Universitý Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Mustapha Maâroufi
- Radiology Department of CHU HASSAN II de Fez, Fez, Morocco
- Faculty of Medecine Fez, Universitý Sidi Mohamed Ben Abdellah, Fez, Morocco
- Laboratoire de Neurosciences, Clinique Faculty of Medecine Fez, Universitý Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Badreddine Alami
- Radiology Department of CHU HASSAN II de Fez, Fez, Morocco
- Faculty of Medecine Fez, Universitý Sidi Mohamed Ben Abdellah, Fez, Morocco
- Laboratoire de Neurosciences, Clinique Faculty of Medecine Fez, Universitý Sidi Mohamed Ben Abdellah, Fez, Morocco
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Trad S, Bonnet C, Monnet D. Uvéite médicamenteuse et effets indésirables des médicaments en ophtalmologie. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Dogan B, Erol MK, Cengiz A. Vogt-Koyanagi-Harada disease following BCG vaccination and tuberculosis. SPRINGERPLUS 2016; 5:603. [PMID: 27247899 PMCID: PMC4864801 DOI: 10.1186/s40064-016-2223-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/22/2016] [Indexed: 11/24/2022]
Abstract
Introduction To describe the characteristics, diagnosis, and treatment of the first documented case of Vogt–Koyanagi–Harada (VKH) disease following BCG vaccination (Patient 1) and the first documented case of both VKH disease and tuberculosis (Patient 2). Two patients were diagnosed with VKH disease and monitored using fundus photography, fundus autofluorescence, fluorescein angiography (FA), spectral-domain optical coherence tomography, and enhanced depth imaging optical coherence tomography (EDI-OCT). Case description A 39-year-old patient (Patient 1) had bilateral granulomatous anterior uveitis and serous retinal detachment. FA showed multiple punctuate hyperfluorescent lesions and multilobular pools of dye. EDI-OCT revealed serous retinal detachment, subretinal septa, and cystoid spaces. A 40-year-old woman (Patient 2) presented with a 3-week history of decreased vision, headache and tinnitus. Fundus examination showed bilateral disc swelling with serous retinal detachment and retinal folds. She had been diagnosed with tuberculosis. EDI-OCT showed fluctuation of the internal limiting membrane (ILM), retinal folds, retinal pigment epithelial (RPE)-Bruch membrane undulation, choroidal folds, serous retinal detachment. Both of the patients received high dosage of steroid treatment during the diagnosis. A fast recovery in VKH symptoms was observed following the treatment. Discussion and evaluation Immunological mechanisms and dysregulation of the immune system may play a significant role in the association between VKH disease and BCG. Conclusions EDI-OCT imaging demonstrated structural changes in the photoreceptor layer, RPE-Bruch membrane, choroid, outer retina, ILM in acute VKH.
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Affiliation(s)
- Berna Dogan
- Department of Ophthalmology, Antalya Training and Research Hospital, Varlık Mh., Kazim Karabekir Caddesi, 07100 Antalya, Turkey
| | - Muhammet Kazim Erol
- Department of Ophthalmology, Antalya Training and Research Hospital, Varlık Mh., Kazim Karabekir Caddesi, 07100 Antalya, Turkey
| | - Ayse Cengiz
- Department of Ophthalmology, Antalya Training and Research Hospital, Varlık Mh., Kazim Karabekir Caddesi, 07100 Antalya, Turkey
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10
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Abstract
Because of their varied spectrum of clinical presentation and difficulty in management, pediatric uveitis remains a challenge to the ophthalmologist. Variations in clinical presentation, difficulties in eye examination, extended burden of the inflammation over quality of life, limited treatment modalities, risk of amblyopia are the main challenges in the management of pediatric uveitis. Pediatric uveitis is a cause of significant ocular morbidity and severe vision loss is found in 25-33% of such cases. This article summarizes the common causes of uveitis in children with special approach to the evaluation and diagnosis of each clinical entity.
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Affiliation(s)
| | - Jyotirmay Biswas
- Director of Uveitis and Ocular Pathology Departments, Sankara Nethralaya, Chennai, India
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Singh R, Toor P, Parchand S, Sharma K, Gupta V, Gupta A. Quantitative polymerase chain reaction for Mycobacterium tuberculosis in so-called Eales' disease. Ocul Immunol Inflamm 2012; 20:153-7. [PMID: 22486260 DOI: 10.3109/09273948.2012.658134] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To report mycobacterial load in the vitreous of patients labeled as having Eales' disease. METHODS Eighty-eight patients were prospectively enrolled into 3 groups: 28 patients with so-called Eales' disease (group A); 30 positive controls with specific uveitis syndromes (group B), and 30 negative controls (group C). The undiluted vitreous humor samples were collected and subjected to real-time PCR assay for MPB64 gene of Mycobacterium tuberculosis (MTB) and load quantified. RESULTS Sixteen (57.14%) vitreous fluid samples in group A; 1 sample in group B, and none of the samples in group C were positive for MTB genome from the vitreous. The copies of MTB genomes in the positive samples in group A were 1.52 × 10(4) to 1.01 × 10(6). CONCLUSION MTB genome was demonstrated in more than 50% of vitreous fluid samples with significant bacillary load, indicating that half of patients with so-called Eales' disease are indeed cases of tubercular vasculitis.
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Affiliation(s)
- Rishiraj Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Tuberculosis is caused by Mycobacterium tuberculosis, transmitted primarily by inhalation of aerosolized droplets containing the organisms. There is an infection of the respiratory tract and the tubercle bacilli spread via lymphatic system and bloodstream to many different organs. Generally, the pulmonary tuberculosis infections are asymptomatic and a positive skin test result is the only indication of it. Approximately 10% of infected individuals develop active disease. Immunosuppression caused by systemic diseases or medication increases the risk of developing tuberculosis. In addition to the pulmonary tract, tuberculosis may affect many organs and systems, including lymph nodes, larynge, middle ear, genitourinary tract, musculoskeletal system, central nervous system, gastrointestinal tract, pericardium, and skin. Ocular involvement is an uncommon event in tuberculous infection, and there are several presentations involving the iris, ciliary body, choroid, retina and optic nerve. The diagnosis is based in the detection of mycobacteria in fluids and tissues. If there is no available material for analysis, a presumptive diagnosis is made and therapeutic test initiated. The therapy is based in anti-tuberculous drugs and corticosteroids. The standard treatment protocol in Brazil includes isoniazid, rifampim, and pyrazinamid for two months, followed by isoniazid and rifampin for four months for susceptible organisms. Alternative regimens are necessary in the presence of drug resistance.
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Affiliation(s)
- Adriana A Bonfioli
- Eye & Ear Institute of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Abstract
PURPOSE To report four cases of Eales' disease in Inuit from Greenland diagnosed within a 6.5-year period. There are no previous reports on Eales' disease among Greenlanders. METHODS Four younger Inuit, three males and one female, were diagnosed with Eales' disease based on fundus changes and exclusion of possible differential diagnoses. Several studies point to a possible relation between Eales' disease and tuberculosis (TB); examination of possible exposure to TB was part of the clinical investigation. RESULTS Retinal changes made panretinal laser photocoagulation necessary in all cases. Four eyes in three patients were vitrectomized. Three patients received oral corticosteroid treatment. The final visual outcome was relatively good, with a visual acuity below 6/60 (3/36) in only one vitrectomized eye. All patients had been exposed to TB. CONCLUSION Eales' disease seems to be rather common in the small population of Inuit (56,000) in Greenland. Attention is required to ensure diagnosis and appropriate treatment, including laser photocoagulation, leading to a reasonably good prognosis.
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Morimura Y, Okada AA, Kawahara S, Miyamoto Y, Kawai S, Hirakata A, Hida T. Tuberculin skin testing in uveitis patients and treatment of presumed intraocular tuberculosis in Japan. Ophthalmology 2002; 109:851-7. [PMID: 11986087 DOI: 10.1016/s0161-6420(02)00973-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
PURPOSE To evaluate the results of tuberculin skin testing in Japanese patients with intraocular inflammation and to assess the outcome of treatment for presumed intraocular tuberculosis in selected patients. DESIGN Prospective, noncomparative, interventional case series. PARTICIPANTS One hundred twenty-six patients, newly referred to the Ocular Inflammation Service at the Kyorin Eye Center from April 1998 to August 2000, underwent systemic evaluation for the diagnosis and/or treatment of uveitis. METHODS Tuberculin skin testing with purified protein derivative was performed as part of the systemic evaluation. The diagnosis of presumed intraocular tuberculosis was made when findings were consistent with possible intraocular tuberculosis, the tuberculin skin test was positive (induration more than 10 mm), and no other cause of uveitis was suggested by symptoms, signs, or ancillary testing. Using these criteria, 10 patients were given a diagnosis of presumed intraocular tuberculosis and treated with antituberculosis therapy consisting of isoniazid, with or without rifampicin. Some of these patients also received a tapered course of oral corticosteroids after the initiation of antituberculosis treatment. None of the patients had any signs or symptoms of acquired immunodeficiency syndrome. MAIN OUTCOME MEASURES Visual acuity and ophthalmologic examination to assess degree of intraocular inflammation. RESULTS Twenty-six of the 126 patients (20.6%) had a positive tuberculin skin test result. Ten of these 26 patients (38.5%) were treated for a diagnosis of presumed intraocular tuberculosis. Nine patients had no evidence of pulmonary tuberculosis, and one patient had presumed tuberculous hilar lymphadenitis. The predominant clinical finding was choroidal or optic disc nodule in three patients, retinal vasculitis in three patients, and choroiditis in four patients. Nine patients exhibited decreased intraocular inflammation with treatment. CONCLUSIONS Roughly one fifth of the uveitis patients who underwent systemic evaluation had a positive tuberculin skin test result, and 9 of 10 selected skin test-positive patients with clinical findings consistent with intraocular tuberculosis had a favorable response to antituberculosis therapy. These results suggest that intraocular tuberculosis continues to be a major diagnostic consideration for uveitis patients in Japan.
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Affiliation(s)
- Yoshihiro Morimura
- Kyorin Eye Center, Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
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Abstract
Eales disease, first described by Henry Eales in 1880, remains an enigma. The disease, observed more commonly in the Indian subcontinent than in the rest of the world, occurs in young healthy adult males, initially presenting as retinal periphlebitis and later as retinal ischemia that may lead to vascular alterations and neovascularization. Recurrent vitreous hemorrhage with or without retinal detachment is the common sequelae. In recent years, immunological, molecular biological, and biochemical studies have indicated the role of human leukocyte antigen, retinal autoimmunity, mycobacterium tuberculosis genome, and free radical mediated damage in the etiopathogenesis of this disease. However, its etiology appears to be multifactorial. The management depends on the stage of the disease and consists of medical treatment with oral corticosteroids in the active inflammatory stage and laser photocoagulation in the advanced retinal ischemia and neovascularization stages. The results of vitreoretinal surgery have been found to be satisfactory in case of vitreous hemorrhage with or without retinal detachment.
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Affiliation(s)
- C M Samson
- Massachusetts Eye and Ear Infirmary, Boston 02114, USA
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Rathinam SR, Namperumalsamy P, Nozik RA, Cunningham ET. Vogt-Koyanagi-Harada syndrome after cutaneous injury. Ophthalmology 1999; 106:635-8. [PMID: 10080227 DOI: 10.1016/s0161-6420(99)90129-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To describe three patients who developed Vogt-Koyanagi-Harada syndrome (VKH) after cutaneous injury. DESIGN Retrospective case series. PARTICIPANTS Three patients seen in the uveitis clinic at Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India, participated. MAIN OUTCOME MEASURES The history, evaluation, and management of the three patients were summarized. RESULTS Three patients developed VKH syndrome shortly after cutaneous injury. In each case, the affected area of skin became vitiliginous on healing and simultaneous with the onset of ocular symptoms. One patient developed additional ectopic areas of vitiligo. All three patients developed chronic, bilateral, diffuse uveitis, one associated with an exudative retinal detachment and two with Dalen-Fuchs-like nodules. Well-recognized complications of VKH syndrome that occurred in the authors' patients included geographic atrophy of the retinal pigment epithelium (3 of 3), cataract (3 of 3), and glaucoma (1 of 3). Ocular inflammation was well controlled in each patient with local or systemic corticosteroids or both. In one patient, the area of vitiligo showed increased pigmentation in response to systemic corticosteroid treatment. CONCLUSIONS Vogt-Koyanagi-Harada syndrome may follow cutaneous injury, supporting the notion that this disorder may result from systemic sensitization to shared melanocytic antigens.
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Affiliation(s)
- S R Rathinam
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India
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Lerner MP, Donoso LA, Nordquist RE, Cunningham MW. Immunological mimicry between retinal S-antigen and group A streptococcal M proteins. Autoimmunity 1995; 22:95-106. [PMID: 8722579 DOI: 10.3109/08916939508995305] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Immunological mimicry between host and microbial proteins has been suggested as a potential mechanism in the development of uveitis in humans. In this study immunological crossreactivity between anti-streptococcal monoclonal antibodies (MAbs) and the human eye was investigated. In indirect immunofluorescence, we demonstrated novel immunological crossreactivity of two anti-streptococcal MAbs (27 and 112) with the rod outer (and inner) segments of the retina of the human eye. In further studies, retinal S-Ag, a uveitogenic protein in the rod outer (and inner) segments, was found to react with the anti-streptococcal MAbs. In addition, several uveitogenic peptides of S-Ag were recognized by the anti-streptococcal MAbs. In the ELISA and Western immunoblot, anti-S-Ag MAbs crossreacted with group A streptococci and the streptococcal M protein further demonstrating sites of antigenic similarity. Homology between the retinal S-Ag and streptococcal M protein was observed in amino acid sequences repeated in the B repeat region of the streptococcal M5 protein. These data show that retinal S-antigen has immunological similarities with streptococcal M protein, a major virulence determinant and strong bacterial cell surface antigen.
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Affiliation(s)
- M P Lerner
- Department of Ophthalmology, University of Oklahoma Health Science Center, Oklahoma City 73190, USA
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