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Alghubaishi SA, Saeed M, Abujamous F, Osman H, Alasmari BG. Recurrent Meningitis and Its Rare Association With Ligneous Conjunctivitis and Congenital Plasminogen Deficiency. Cureus 2023; 15:e44813. [PMID: 37818495 PMCID: PMC10561533 DOI: 10.7759/cureus.44813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/06/2023] [Indexed: 10/12/2023] Open
Abstract
This case report explores the rare association of recurrent meningitis, hydrocephalus, ligneous conjunctivitis, and congenital plasminogen deficiency in a term baby boy. Born at 39 weeks with a history of hydrocephalus, the neonate later developed ligneous conjunctivitis and a serious bout of meningitis. Genetic analyses confirmed a homozygous mutation in the PLG gene, indicative of congenital plasminogen deficiency. Despite intensive treatment, including a ventriculoperitoneal shunt for hydrocephalus and intravenous antibiotics for meningitis, the child succumbed to upper airway obstruction before reaching one year of age. This report underscores the medical complexity and severity of these interconnected conditions and advocates for further research to understand the interplay between them. Although this study is limited by its single-case nature and is not generalizable, it emphasizes the necessity for early recognition and a multidisciplinary treatment approach for better patient outcomes.
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Affiliation(s)
| | - Muhammad Saeed
- Pediatric Neurology, Armed Forces Hospital - Southern Region, Khamis Mushait, SAU
| | - Fadi Abujamous
- Pediatrics, Armed Forces Hospital - Southern Region, Khamis Mushait, SAU
| | - Hussam Osman
- Ophthalmology, Armed Forces Hospital - Southern Region, Khamis Mushait, SAU
| | - Badriah G Alasmari
- Pediatrics, Armed Forces Hospital - Southern Region, Khamis Mushait, SAU
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Li J, Liu R, Ren T, Zhang H, Ma J. A case of IgG4-positive ligneous conjunctivitis mistaken for a conjunctival mass. Diagn Pathol 2023; 18:77. [PMID: 37386507 DOI: 10.1186/s13000-023-01366-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Ligneous conjunctivitis (LC) is a rare inflammatory lesion of the conjunctiva with an unknown etiology. It is easily confused with conjunctiva lymphoma or other diseases in clinical diagnosis, and the lesion is very difficult to treat. CASE PRESENTATION We presented a 41-year-old female patient presented with bilateral conjunctival masses for more than six months. The patient had no contributory history of ocular trauma, family history of tumor and drug allergy. Taking the patient's clinical and pathological features together, we considered this was a case of IgG4 + LC. Completely surgical resection combined with local glucocorticoid treatment might be effective. CONCLUSIONS This is a very rare case report of immunoglobulin G4 positive LC with only one published case in literature. The typical manifestations of LC are with the appearance of a hard, fibrin-rich, woody pseudomembranous lesion. A large number of lymphocyte and plasma cell are infiltrated in the pathological tissue. Inflammation of LC may cause immune abnormalities, resulting in IgG4 increasing.
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Affiliation(s)
- Jing Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Rui Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Tingting Ren
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Hong Zhang
- Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jianmin Ma
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Alqaidy D, Moran CA. Ligneous brochitis: A clinicopathological correlation of seven cases. Pathol Res Pract 2023; 244:154412. [PMID: 36921544 DOI: 10.1016/j.prp.2023.154412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
Seven patients with ligneous lesions of the bronchus are presented. The patients are five men and two women between the ages of 51 and 79 years (average: 65) who had prior history of pulmonary non-small cell carcinoma in the past 2-3 years. All the patients had undergone surgical resection followed by chemotherapy. The patients were evaluated for the potential recurrence of carcinoma and bronchial biopsies were obtained. Histologically, all the cases shared similar features, manly the presence of a subepithelial amorphous, acellular, eosinophilic material with minimal inflammatory reaction. Special histochemical stains for micro-organisms were negative as well as congo red for the presence of amyloid. No evidence of malignancy was seen in any of the biopsies. The current cases, represent an unusual histological feature that is more in keeping with ligneous bronchitis, possibly secondary to treatment.
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Affiliation(s)
- Doaa Alqaidy
- Department of Pathology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Cesar A Moran
- The University of Texas, M D Anderson Cancer Center, Houston, TX, USA.
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Merlevede V, Ninclaus V, Roels D, Huys L, Callewaert B, Kreps EO. Ligneous conjunctivitis mimicking preseptal cellulitis in a 3-month-old infant. Ophthalmic Genet 2023; 44:103-106. [PMID: 35769059 DOI: 10.1080/13816810.2022.2092756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Ligneous conjunctivitis is a very rare form of pseudomembranous conjunctivitis with few published cases in literature. We aim to describe the ocular findings and treatment in an infant with ligneous conjunctivitis resembling preseptal cellulitis on presentation. MATERIALS AND METHODS Case report of a 3-month-old girl who was referred to a tertiary centre for ophthalmic assessment due to progressive eyelid oedema with no response to initiated topical and systemic antibiotics. Ethical approval has been achieved from the local ethics committee of the Ghent University Hospital and informed consent has been obtained from the parents of the child. RESULTS Examination under general anaesthesia showed multiple, wood-like fibrinous pseudomembranes, originating from the conjunctiva, consistent with ligneous conjunctivitis. After careful removal of the coagulated exudate covering the cornea, a central corneal epithelial defect was evident without stromal infiltration. Histopathologic examination confirmed the predominance of fibrin within the pseudomembranes. Plasminogen activity was below the normal range. Genetic analysis did not identify a pathogenic variant in the PLG gene. The corneal epithelium re-epithelialised during the following days and the conjunctival lesions gradually subsided over the ensuing weeks whilst continuing heparin-containing artificial tears. CONCLUSION A high level of suspicion is warranted in atypical cases of preseptal cellulitis which show no response to antibiotic treatment. Particularly in young children, examination under general anesthesia is warranted to allow diagnosis of rare causes of secondary eyelid oedema. We report an infant with unilateral ligneous conjunctivitis who responded well to topical, commercially-available heparin-containing artificial tears treatment. This approach is an effective and easy first-line treatment option in this condition, particularly in milder phenotypes.
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Affiliation(s)
| | - Virginie Ninclaus
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.,Faculty of Medical Sciences, Ghent University, Ghent, Belgium
| | - Dimitri Roels
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.,Faculty of Medical Sciences, Ghent University, Ghent, Belgium
| | - Liesbeth Huys
- Department of Pharmacy, Ghent University, Ghent, Belgium
| | - Bert Callewaert
- Faculty of Medical Sciences, Ghent University, Ghent, Belgium.,Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium
| | - Elke O Kreps
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.,Faculty of Medical Sciences, Ghent University, Ghent, Belgium
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Koseoglu ND, Ceylaner S, Yildirim N. A Novel mRNA Modification Mutation in a Patient With Ligneous Conjunctivitis Coexisting With Heterozygous Familial Mediterranean Fever Mutation. Cornea 2021; 40:764-768. [PMID: 33734159 DOI: 10.1097/ico.0000000000002702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/18/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a novel mRNA mutation associated with ligneous conjunctivitis (LC) in a patient with heterozygous familial Mediterranean fever (FMF) mutation. METHODS Case presentation of a patient with LC and heterozygous FMF mutation. The patient was evaluated for various genetically predisposed inflammatory diseases through whole exome sequencing. RESULTS LC is a rare inflammatory ocular pathology presenting with recurrent conjunctivitis episodes with eosinophilic fibrin-rich pseudomembranes. FMF is an autoinflammatory disease presenting with recurrent episodes of fever, arthritis, and other inflammatory conditions. Various plasminogen (PLG) gene mutations have been identified in LC, whereas a variety of mutations in the Mediterranean fever (MEFV) gene have been identified in FMF patients. Based on the inflammatory nature of both pathologies, we aimed to evaluate and identify any potential common genetic pathway. We were not able to identify any mutation in PLG gene through whole gene sequencing; however, the patient was positive for heterozygous M680I FMF mutation, and we observed 22% of NM_000301.3:c.2130T>G (p.T710=) variant in mRNA isolated from affected tissue, which was not present in DNA sequence. CONCLUSIONS To the best of our knowledge, this is the first case of LC caused by an mRNA mutation coexisting with another genetically predisposed autoinflammatory disease mutation.
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Affiliation(s)
- Neslihan D Koseoglu
- Department of Ophthalmology, Eskisehir Osmangazi University, Eskisehir, Turkey ; and
| | - Serdar Ceylaner
- Intergen Genetic and Rare Disorders Diagnosis and Research Center, Ankara, Turkey
| | - Nilgun Yildirim
- Department of Ophthalmology, Eskisehir Osmangazi University, Eskisehir, Turkey ; and
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Mérigot C, Viard C, Pechmeja J, Eyvrard F, Sorli SC. [Pharmaceutical supply of human plasminogen replacement therapy for the treatment of ligneous conjunctivitis: Logistics for a university hospital]. J Fr Ophtalmol 2021; 44:1008-1020. [PMID: 34049718 DOI: 10.1016/j.jfo.2020.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022]
Abstract
In order to treat a pediatric patient with ligneous conjunctivitis secondary to congenital plasminogen deficiency, a supply of topically administered replacement human plasminogen has been required. In the absence of market approval, this blood-derived drug is managed by a temporary authorisation for nominative use, allowing monthly hospital dispensations. To ensure regulatory compliance and proper use of the drug, it took two years of interactions between various hospital departments and the laboratory to define the pharmaceutical supply chain in our hospital and allow the patient to receive treatment. The main difficulties lie in respecting the cold chain of this drug stored frozen in the bottles not ready for use. Transportation from the laboratory to the patient's home via the hospital pharmacy is carried out in calibrated conditions, ensuring a temperature below -20°C for 72h. Reception and dispensing steps were combined into a single pharmaceutical service in order to optimise transport time while ensuring the safety and traceability of the drug lots. Each month, a date is scheduled between the hospital pharmacy, the laboratory and the family to ensure that delivery and dispensing take place on the same day. Appropriate use and handling are explained to the family. However, two issues remain to be addressed by the manufacturer to facilitate future use of human plasminogen: the thermostability problem, which does not allow stays away from home longer than three days, and self-administration by the child, which is unlikely to be feasible due to handling difficulties.
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Affiliation(s)
- C Mérigot
- Service pharmacie essais cliniques-autorisation temporaire d'utilisation- rétrocessions, hôpital Paule-de-Viguier, centre hospitalier universitaire de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - C Viard
- Service pharmaceutique référent de la pédiatrie, hôpital Paule-de-Viguier, centre hospitalier universitaire de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - J Pechmeja
- Service ophtalmologie, hôpital Pierre-Paul-Riquet, centre hospitalier universitaire de Toulouse, place du Docteur-Baylac, 31059 Toulouse, France
| | - F Eyvrard
- Service pharmacie essais cliniques-autorisation temporaire d'utilisation- rétrocessions, hôpital Paule-de-Viguier, centre hospitalier universitaire de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - S C Sorli
- Service pharmacie essais cliniques-autorisation temporaire d'utilisation- rétrocessions, hôpital Paule-de-Viguier, centre hospitalier universitaire de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France.
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Xu L, Sun Y, Yang K, Zhao D, Wang Y, Ren S. Novel homozygous mutation of plasminogen in ligneous conjunctivitis: a case report and literature review. Ophthalmic Genet 2021; 42:105-109. [PMID: 33427557 DOI: 10.1080/13816810.2020.1867753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background:Ligneous conjunctivitis (LC) is a rare disease characterized by the development of a wood-like pseudomembrane on the tarsal conjunctiva secondary to type I plasminogen deficiency. Here we reported on a Chinese patient with LC in a consanguineous family and performed a literature review of all reported mutations for this disease. Methods: A 13-month-old girl diagnosed with LC and her parents were included in this study. Hematoxylin and eosin staining was used to perform histopathology examination. The plasminogen activity was determined by chromogenic assay. Sanger sequencing was performed to screen the mutation site for the disease. In silico analysis was applied to predict the pathogenesis of the identified mutation. In addition, we reviewed the literatures on PLG mutations of LC. Results: Histopathology examination revealed the infiltration of inflammatory cells on membranous lesions. Plasma plasminogen activity was severely decreased in the patient and moderately decreased in her parents (patient: plasminogen activity, 2.50%; father: plasminogen activity, 41.02%; mother: plasminogen activity, 54.07%). Co-segregation analysis indicated that the patient was homozygous for the c.763 G > A (p.Glu255Lys) mutation in plasminogen gene (PLG). Bioinformatics analysis strongly suggested that the mutation was damaging for the disease. The model analysis indicated the mutation might cause abnormal spatial structure and low stability, thus affecting functional activity. A literature review of the LC mutations indicated a strong genetic heterogeneity of the disease. Conclusions: LC exhibited strong genetic heterogeneity, and our study identified a novel homozygous missense mutation of plasminogen (c.763 G > A, p.Glu255Lys) in one Chinese patient with LC.
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Affiliation(s)
- Liyan Xu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Yajie Sun
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Kaili Yang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Dongqing Zhao
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Yiqiang Wang
- Central Lab, Xiang'an Hospital of Xiamen University, and Eye Institute of Xiamen University, Xiamen University, Xiamen, China
| | - Shengwei Ren
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
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