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Muacevic A, Adler JR, Mun-Wei L, Ismail AS, Yaakub A. Infectious Sclerouveitis in an Immunocompetent Patient: A Probable Case of Simultaneous Ocular Tuberculosis and Toxoplasmosis. Cureus 2022; 14:e31726. [PMID: 36569731 PMCID: PMC9769460 DOI: 10.7759/cureus.31726] [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] [Accepted: 11/21/2022] [Indexed: 11/23/2022] Open
Abstract
Simultaneous infections of tuberculosis and toxoplasmosis are uncommon in immunocompetent patients. We report a case of a 30-year-old male who presented with right eye redness and blurring of vision for one month. The visual acuities were hand movement and Snellen 20/30 in the right and left eyes, respectively. Panuveitis and scleritis were found in the right eye, together with dense vitritis and a large choroidal lesion that extended from the inferonasal to the superotemporal quadrants. B-scan ultrasonography of the right eye showed a choroidal detachment with scleral thickening and subtenon fluid. His IgM anti-Toxoplasma antibody was detected, and his QuantiFERON Gold testing was positive. Magnetic resonance imaging (MRI) of the orbit revealed an enhancing intraocular mass at the lateral and inferior aspects of the right globe. The diagnosis of right eye sclerouveitis with presumed tuberculosis and toxoplasmosis co-infections was made. He was treated with a course of oral azithromycin and anti-tubercular therapy along with systemic prednisolone and a topical steroid. The treatment reduced the inflammation; however, the patient suffered from a sequela of chronic uveitis with prolonged hypotony. Medical treatment alone may be insufficient in treating severe infective sclerouveitis, hence surgical intervention might be warranted to provide favorable clinical outcomes.
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Patel PR, Farrell MC, Peshtani A, Berkenstock MK. Bilateral anterior and posterior scleritis in a patient with acute myelogenous leukemia. Am J Ophthalmol Case Rep 2022; 26:101497. [PMID: 35372712 PMCID: PMC8971595 DOI: 10.1016/j.ajoc.2022.101497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 03/02/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Pujan R. Patel
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Ani Peshtani
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Meghan K. Berkenstock
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Corresponding author. Wilmer Eye Institute, 600 N. Wolfe St. Maumenee Third Floor Baltimore, MD, 21287, USA.
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Matsuda K, Fukami H, Saito A, Sato H, Aoki S, Takeuchi Y, Nakajima S, Nagasawa T. Rapidly progressive renal failure due to tubulointerstitial infiltration of peripheral T-cell lymphoma, not otherwise specified accompanied by uveitis: a case report. BMC Nephrol 2018; 19:312. [PMID: 30409117 PMCID: PMC6225725 DOI: 10.1186/s12882-018-1125-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/26/2018] [Indexed: 11/15/2022] Open
Abstract
Background Rapid decline in renal dysfunction due to primary renal lymphoma, or secondary renal lymphoma by infiltration from a primary origin, is extremely rare. There are notably few reports indicating infiltration of T-cell lymphoma into the kidney. Case presentation A 61-year-old woman with a sudden body rash and liver dysfunction was brought to our hospital presenting with a dull headache and blurred vision. Laboratory tests revealed rapidly progressive renal failure. Histological examination of the kidney and skin indicated infiltration of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). Infiltration of PTCL-NOS to the liver and spleen, and presence of Uveitis masquerade syndrome were suspected. Imaging showed that the lesion was limited to extralymphatic organs. Renal function was improved with administration of steroids, including pulse steroid therapy, before administering cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) therapy. Conclusions This is the first reported case of rapidly progressive renal failure caused by perivascular tubulointerstitial nephritis with the direct invasion of PTCL-NOS. In our case, a single steroid dose showed dramatic results with respect to renal symptoms.
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Affiliation(s)
- Ken Matsuda
- Department of Nephrology, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichisita Hebita Ishinomaki, Miyagi, 986-8522, Japan.
| | - Hirotaka Fukami
- Department of Nephrology, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichisita Hebita Ishinomaki, Miyagi, 986-8522, Japan
| | - Ayako Saito
- Department of Nephrology, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichisita Hebita Ishinomaki, Miyagi, 986-8522, Japan
| | - Hiroyuki Sato
- Department of Nephrology, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichisita Hebita Ishinomaki, Miyagi, 986-8522, Japan
| | - Satoshi Aoki
- Department of Nephrology, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichisita Hebita Ishinomaki, Miyagi, 986-8522, Japan
| | - Yoichi Takeuchi
- Department of Nephrology, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichisita Hebita Ishinomaki, Miyagi, 986-8522, Japan
| | - Shinji Nakajima
- Department of Hematology, Japanese Red Cross Ishinomaki Hospital, Miyagi, Japan
| | - Tasuku Nagasawa
- Department of Nephrology, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichisita Hebita Ishinomaki, Miyagi, 986-8522, Japan
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Hughes E, Fogarty H, Fortune A, Keegan D. Ocular presentation of natural killer/T-cell lymphoma in a Caucasian man. BMJ Case Rep 2016; 2016:bcr-2016-215089. [PMID: 27118749 DOI: 10.1136/bcr-2016-215089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Natural killer/T-cell (NK/T-cell) lymphoma-nasal subtype, is a rare form of non-Hodgkin's lymphoma, most common in South East Asia, and can have an ophthalmological presentation. This report describes a 51-year-old Caucasian man with uveitis, recurrent retinal detachment and paraneoplastic features subsequently diagnosed as NK/T-cell lymphoma.
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Affiliation(s)
- Emily Hughes
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Helen Fogarty
- Department of Haematology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Anne Fortune
- Department of Haematology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - David Keegan
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin 7, Ireland
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Kirkegaard MM, Coupland SE, Prause JU, Heegaard S. Malignant lymphoma of the conjunctiva. Surv Ophthalmol 2015; 60:444-58. [PMID: 26003619 DOI: 10.1016/j.survophthal.2015.05.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/06/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
Abstract
Conjunctival lymphomas constitute 25% of all ocular adnexal lymphomas. The majority are B-cell non-Hodgkin lymphomas (NHLs) (98%), whereas conjunctival T-cell NHLs are rare (2%). The most frequent subtype of conjunctival B-cell lymphoma is extranodal marginal zone lymphoma (EMZL; 81%), followed by follicular lymphoma (8%), diffuse large B-cell lymphoma (3%), and mantle cell lymphoma (3%). Extranodal marginal zone lymphoma occurs slightly more often in women and, along with follicular lymphoma, presents late in the seventh decade of life, whereas diffuse large B-cell lymphoma and especially mantle cell lymphoma have a predilection for the male gender and typically present in the eighth decade. Extranodal marginal zone lymphoma and follicular lymphoma present most frequently in the forniceal and bulbar conjunctiva. Conjunctival diffuse large B-cell lymphoma, mantle cell lymphoma and T-cell NHLs are characterized by a short duration of symptoms before the first ophthalmologic consultation. External beam radiotherapy is the treatment of choice for extranodal marginal zone lymphoma and follicular lymphoma, whereas diffuse large B-cell lymphoma, mantle cell lymphoma, and T-cell NHLs are mainly treated with chemotherapy. Conjunctival T-cell NHLs are associated with a particularly poor prognosis, with 50% of patients having progression or recurrence during a 1-year follow-up period.
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Affiliation(s)
- Marina M Kirkegaard
- Department of Neuroscience and Pharmacology, Eye Pathology Institute, University of Copenhagen, Copenhagen, Denmark
| | | | - Jan U Prause
- Department of Neuroscience and Pharmacology, Eye Pathology Institute, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Neuroscience and Pharmacology, Eye Pathology Institute, University of Copenhagen, Copenhagen, Denmark; Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
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Patel DS, Rundle P, Salvi SM, Fernando M, Mudhar HS. Conjunctival Angioimmunoblastic T-Cell Lymphoma. Ocul Oncol Pathol 2014; 1:71-6. [PMID: 27231687 DOI: 10.1159/000368247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/05/2014] [Indexed: 11/19/2022] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) represents an uncommon variant of T-cell lymphomas and most often presents insidiously with systemic symptoms. This report constitutes the first documented case of conjunctival AITL, masquerading as nodular episcleritis, and describes both the clinical and pathological findings. Furthermore, conjunctival T-cell lymphoma in general remains a rare occurrence, and a survey of previously reported cases reveals a wide variation in clinical presentation. A high index of suspicion, thorough examination and conjunctival biopsy are essential to reaching the diagnosis of conjunctival lymphoma.
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Affiliation(s)
- Darshak S Patel
- Sheffield Ocular Oncology Centre, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| | - Paul Rundle
- Sheffield Ocular Oncology Centre, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| | - Sachin M Salvi
- Sheffield Ocular Oncology Centre, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| | - Malee Fernando
- Department of Histopathology, Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
| | - Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
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Ponzoni M, Govi S, Licata G, Mappa S, Giordano Resti A, Politi LS, Spagnuolo L, Di Cairano E, Doglioni C, Ferreri AJM. A reappraisal of the diagnostic and therapeutic management of uncommon histologies of primary ocular adnexal lymphoma. Oncologist 2013; 18:876-84. [PMID: 23814042 DOI: 10.1634/theoncologist.2012-0425] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Lymphoma is the most common malignancy arising in the ocular adnexa, which includes conjunctiva, lachrymal gland, lachrymal sac, eyelids, orbit soft tissue, and extraocular muscles. Ocular adnexal lymphoma (OAL) accounts for 1%-2% of non-Hodgkin lymphoma and 5%-15% of extranodal lymphoma. Histology, stage, and primary localizations are the most important variables influencing the natural history and therapeutic outcome of these malignancies. Among the various lymphoma variants that could arise in the ocular adnexa, marginal zone B-cell lymphoma (OA-MZL) is the most common one. Other types of lymphoma arise much more rarely in these anatomical sites; follicular lymphoma is the second most frequent histology, followed by diffuse large B-cell lymphoma and mantle cell lymphoma. Additional lymphoma entities, like T-cell/natural killer cell lymphomas and Burkitt lymphoma, only occasionally involve orbital structures. Because they are so rare, related literature mostly consists of anecdotal cases included within series focused on OA-MZL and sporadic case reports. This bias hampers a global approach to clinical and molecular properties of these types of lymphoma, with a low level of evidence supporting therapeutic options. This review covers the prevalence, clinical presentation, behavior, and histological and molecular features of uncommon forms of primary OAL and provides practical recommendations for therapeutic management.
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Affiliation(s)
- Maurilio Ponzoni
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, San Raffaele Scientific Institute, Milan, Italy.
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Isola V, Mazzacane D, Defelice N, D'Amico A, Dezza L, Marti A, Pece A. Malignant conjunctival T cell lymphoma diagnosed by punch biopsy as a primary manifestation of systemic cancer. Clin Ophthalmol 2012; 6:777-80. [PMID: 22693420 PMCID: PMC3367434 DOI: 10.2147/opth.s28499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This report documents a case of T cell lymphoma manifesting only with a conjunctival mass. A 67-year-old man underwent a diagnostic punch biopsy, histopathological examination, and immunohistochemical study for a pink-yellow colored mass infiltrating the bulbar conjunctiva in the lower fornix of the eyelid. A biopsy specimen of the conjunctival mass was found histopathologically to be a malignant T cell lymphoma. Systemic involvement was diagnosed within four weeks after the initial diagnosis by computed tomography, showing evidence of extension at the level of the ethmoidal cells, optic nerve, periorbital tissue, and pancreas. T cell lymphoma of the conjunctiva as a primary manifestation of systemic cancer is an uncommon entity. Punch biopsy may be the first diagnostic pathway useful to initiate a search for systemic involvement of a malignant lymphoid tumor of T cell lineage.
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Affiliation(s)
- Vincenzo Isola
- Department of Ophthalmology, Melegnano Hospital, Milan, Italy
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Noh SJ, Kie JH, Kim HY. A Case of Primary Eyelid Peripheral T-Cell Lymphoma, Not Otherwise Specified. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.11.1685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Si Jin Noh
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Hae Kie
- Department of Pathology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Hye Young Kim
- Department of Ophthalmology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
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Pate DO, Gilger BC, Suter SE, Clode AB. Diagnosis of intraocular lymphosarcoma in a dog by use of a polymerase chain reaction assay for antigen receptor rearrangement. J Am Vet Med Assoc 2011; 238:625-30. [DOI: 10.2460/javma.238.5.625] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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