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Lee K, Jung S, Chin HS. Frosted Branch Angiitis; Case Series and Literature Review. Ocul Immunol Inflamm 2024; 32:31-39. [PMID: 36441990 DOI: 10.1080/09273948.2022.2148112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Frosted branch angiitis (FBA) is a rare form of retinal vasculitis. Four case series and an extensive literature review of 236 cases were conducted to clarify the characteristics of this rare condition. METHODS Case series and literature review. RESULTS An analysis of the reported cases revealed that a majority (54.6%) developed FBA in the presence of an underlying disease, with recurrence and complications requiring surgical intervention being rare. The frequency of bilateral occurrence (55.0%) and prevalence in female patients (45.0%) were noted to be lower than previously reported. CONCLUSION In general, idiopathic FBAs are more likely to be bilateral and diagnosed at a younger age than secondary FBAs. In idiopathic FBA, fundus involvement is more generalized, exudates tend to be more translucent, and extensive retinal hemorrhage tends to be less frequent. However, there were no differential characteristic fundus features that clearly distinguished idiopathic FBA from secondary FBA.
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Affiliation(s)
- Kanghoon Lee
- Department of Ophthalmology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Soyeon Jung
- Department of Ophthalmology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Hee Seung Chin
- Department of Ophthalmology, Inha University School of Medicine, Incheon, Republic of Korea
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Huynh E, Chronopoulos A, Schutz JS, Claus B, Erwemi M, Krastel H, Hattenbach L. Frosted branch angiitis as an immune recovery response in newly diagnosed acquired immunodeficiency syndrome and systemic cytomegalovirus infection. Clin Case Rep 2023; 11:e6895. [PMID: 36762146 PMCID: PMC9896155 DOI: 10.1002/ccr3.6895] [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: 10/16/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
Frosted branch angiitis (FBA) is an uncommon form of severe retinal perivasculitis associated with systemic inflammatory/infectious diseases. In this report, we describe a case of FBA and macular edema as a result of immune recovery response in a patient newly diagnosed with HIV infection and cytomegalovirus viremia.
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Affiliation(s)
- Elisa Huynh
- Department of OphthalmologyLudwigshafen HospitalLudwigshafen am RheinGermany
| | | | - James Scott Schutz
- Department of OphthalmologyLudwigshafen HospitalLudwigshafen am RheinGermany
| | - Bernd Claus
- Department of Internal Medicine ALudwigshafen HospitalLudwigshafen am RheinGermany
| | - Marwa Erwemi
- Department of Ophthalmology, Medical Faculty MannheimRuprecht‐Karls‐University HeidelbergMannheimGermany
| | - Hermann Krastel
- Department of Ophthalmology, Medical Faculty MannheimRuprecht‐Karls‐University HeidelbergMannheimGermany
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Farese G, Lorenz AT, Bocqué C, Szurman P, Rickmann A. [Frosted branch angiitis-Rare differential diagnosis of retinal vasculitis]. DIE OPHTHALMOLOGIE 2022; 119:1047-1050. [PMID: 35006309 DOI: 10.1007/s00347-021-01563-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 01/26/2023]
Affiliation(s)
- Gerardo Farese
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland.
| | - Anna Theresa Lorenz
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - Catheline Bocqué
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - Peter Szurman
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - Annekatrin Rickmann
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
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Frosted Branch Angiitis Associated With Cytomegalovirus in a Pediatric Autologous Stem Cell Transplant Patient: Case Report and Review of the Literature. J Pediatr Hematol Oncol 2022; 44:e479-e481. [PMID: 34486563 DOI: 10.1097/mph.0000000000002318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Frosted branch angiitis (FBA) is a rare phenomenon of panuveitis which may occur secondary to cytomegalovirus (CMV) causing acute visual disturbances. CMV infection is a known complication in allogenic stem cell transplant (SCT) patients but is uncommon following autologous SCT. OBSERVATION We describe a 17-month-old medulloblastoma patient with sudden onset visual impairment following second autologous SCT. The patient was CMV seropositive, polymerase chain reaction negative before second SCT. At the time of presentation with visual complaints, the patient was diagnosed with FBA associated with CMV reactivation. Treatment included antivirals and immunosuppressive medication with visual recovery. CONCLUSION FBA induced by CMV should be considered as a differential diagnosis in pediatric patients undergoing autologous bone marrow transplant with rapidly progressive visual impairment.
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Tang S, Zhao N, Wang LY, Wen Y. Frosted branch angiitis due to cytomegalovirus-associated unmasking immune reconstitution inflammatory syndrome: a case report and literature review. BMC Infect Dis 2021; 21:613. [PMID: 34174839 PMCID: PMC8236202 DOI: 10.1186/s12879-021-06311-4] [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: 12/31/2020] [Accepted: 06/10/2021] [Indexed: 11/20/2022] Open
Abstract
Background Cytomegalovirus (CMV) retinitis is a common opportunistic infection in patients with acquired immunodeficiency syndrome. The common funduscopic manifestations are haemorrhagic necrotising variety and granular variety. Frosted branch angiitis (FBA), as a special form, when it occurred after antiretroviral therapy(ART), could possibly be associated with immune reconstitution. We report a case of FBA secondary to CMV infection-associated unmasking immune reconstitution inflammatory syndrome (IRIS). Case presentation A 27-year-old man with human immunodeficiency virus infection developed FBA after 35 days of ART. The left Aqueous humour (AqH) tested positive for CMV DNA, and the patient was diagnosed with CMV retinitis. The degree of intraocular inflammation was reflected by increased levels of interleukin (IL)-6 and IL-8 in AqH. After anti-CMV treatment and continuous ART for several months, his FBA and vision significantly improved. CMV DNA became undetectable in the left AqH, and the IL-6 and IL-8 levels in AqH decreased. Conclusion FBA could be a sign of CMV-associated unmasking IRIS. Anti-CMV treatment alone or combination with steroid treatment may be administered, depending on the changes in CMV DNA load and immunologic profile of AqH.
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Affiliation(s)
- Shi Tang
- Infectious Diseases Department, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
| | - Ning Zhao
- Department of Ophthalmology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Li Yang Wang
- Department of Gastroenterology, The sixth People's Hospital of Shenyang, Shenyang, Liaoning Province, China
| | - Ying Wen
- Infectious Diseases Department, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China.
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Karkhur S, Soni D, Sharma B. Commentary: A challenge of paradoxical worsening and immune reconstitution uveitis. Indian J Ophthalmol 2020; 68:2048-2049. [PMID: 32823476 PMCID: PMC7690503 DOI: 10.4103/ijo.ijo_1583_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Samendra Karkhur
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Deepak Soni
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Bergua A, Galiano M, Hohberger B, Rudolph M. [Frosted branch angiitis : Clinical findings and Spectralis OCT follow-up]. Ophthalmologe 2017; 113:699-703. [PMID: 26612759 DOI: 10.1007/s00347-015-0181-9] [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] [Indexed: 11/29/2022]
Abstract
Frosted branch angiitis is a special form of retinal vasculitis, which has only rarely been reported in the literature. Although the majority of cases of frosted branch angiitis are idiopathic, a systematic clinical work-up should be done in order to exclude other causes, such as infectious and autoimmune diseases. The aim of this study was to correlate the clinical findings with the images obtained during follow-up by spectral domain optical coherence tomography (OCT).
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Affiliation(s)
- A Bergua
- Augenklinik am Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Deutschland.
| | - M Galiano
- Kinderklinik am Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - B Hohberger
- Augenklinik am Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Deutschland
| | - M Rudolph
- Augenklinik am Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Deutschland
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Association between high cytomegalovirus antibody titers and blood pressure in the adult Kazakh and Han Chinese populations. Wien Klin Wochenschr 2017; 129:709-716. [PMID: 28776103 DOI: 10.1007/s00508-017-1239-2] [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: 09/18/2016] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Human cytomegalovirus (CMV) has been linked to the pathogenesis of elevated arterial blood pressure (BP). Our study aimed to determine the association between anti-CMV titers and arterial BP in the Kazakh and Han Chinese populations. MATERIAL AND METHODS Kazakh and Han (n = 800 each) (age, ≥18 years) subjects from Xinjiang, China were examined for anti-CMV immunoglobulin (Ig)G titers using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. The highest anti-CMV titer tertiles determined within gender and ethnicity groups were compared against the two lower tertiles and seronegative samples. RESULTS Multivariate linear regression analysis revealed that anti-CMV titers were independent determinants for elevated systolic (p = 0.006) BP in Kazakh women and inversely associated with systolic (p = 0.004) and mean arterial (p = 0.019) BP in Han women. CONCLUSION The association between CMV infection and/or resulting immune response and BP elevation differed by sex and ethnicity. In Kazakh women, they were associated with elevated BP and the opposite was true among Han women.
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Mao F, Wu J, Sun H, You Q, Li D. Frosted branch angiitis in an AIDS patient with cytomegalovirus retinitis. Int J Infect Dis 2016; 52:9-11. [PMID: 27640360 DOI: 10.1016/j.ijid.2016.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 10/21/2022] Open
Abstract
A case of frosted branch angiitis in an AIDS patient with cytomegalovirus (CMV) retinitis is reported. The use of PCR techniques for CMV DNA detection in intraocular fluid was helpful in this situation. The appropriate therapy was given promptly due to the timely diagnosis based on this assay.
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Affiliation(s)
- Feifei Mao
- Department of Ophthalmology, and The National Clinical Key Department of Infectious Diseases, Beijing DiTan Hospital, Capital Medical University, 100015, Beijing, China
| | - Jianhua Wu
- Hubei Lichuan National Hospital of Traditional Chinese Medicine, Hubei, China
| | - Huiyu Sun
- Department of Ophthalmology, and The National Clinical Key Department of Infectious Diseases, Beijing DiTan Hospital, Capital Medical University, 100015, Beijing, China.
| | - Qisheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dan Li
- Department of Ophthalmology, and The National Clinical Key Department of Infectious Diseases, Beijing DiTan Hospital, Capital Medical University, 100015, Beijing, China
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Zheng XY, Xu J, Li W, Li SS, Shi CP, Zhao ZY, Mao JH, Chen X. Frosted Branch Angiitis in Pediatric Dyskeratosis Congenita: A Case Report. Medicine (Baltimore) 2016; 95:e3106. [PMID: 27015183 PMCID: PMC4998378 DOI: 10.1097/md.0000000000003106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Dyskeratosis congenita (DC) is an inherited bone marrow failure syndrome, usually presented with abnormal skin pigmentation, nail dystrophy, and oral leukoplakia. The main cause of mortality in DC is immunodeficiency and vital infection. DC involves multisystem, but retinal involvements are rare.Herein, we report an unusual case of pediatric DC suffering from frosted branch angiitis (FBA) after recovery of mycoplasma pneumonia. Cytomegalovirus infection and cytokine changes were found relevant to the onset of FBA. Despite corticosteroids, antiviral medication, and hematopoietic stem cell transplantation, the patient ended in poor vision with optic atrophy.This case implies that pediatricians should be aware of FBA as a rare retinal manifestation in children with DC and bone marrow failure. Cytomegalovirus may be one of the common causes and cytokines could be triggering factors.
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Affiliation(s)
- Xiao-Yu Zheng
- From the Department of Ophthalmology (X-YZ, C-PS); Department of Hematology-Oncology (S-SL); Department of Child Health Care (Z-YZ); Department of Nephrology (J-HM); the Central Lab (WL, XC), The Children's Hospital of Zhejiang University School of Medicine, Hangzhou; and Department of Ophthalmology (JX), the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Chawla R, Bypareddy R, Venkatesh P, Tomar AS. Idiopathic Frosted Branch Angiitis in a 2-Year-Old Boy. J Pediatr Ophthalmol Strabismus 2015. [PMID: 26214723 DOI: 10.3928/01913913-20150623-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Alexander JL, Miller M. A case of frosted branch angiitis in an immunocompromised child. J AAPOS 2015; 19:75-6. [PMID: 25727593 DOI: 10.1016/j.jaapos.2014.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 08/12/2014] [Accepted: 08/30/2014] [Indexed: 11/29/2022]
Abstract
Frosted branch angiitis is a rare vascular reaction believed to be a nonspecific immune response to an infective, neoplastic, or idiopathic insult. The clinical presentation is characteristic and typically affects children and younger adults, and the prognosis is good. We report a case of frosted branch angiitis during immune recovery in a 2-year-old boy with Langerhans cell histiocytosis on systemic immunosuppressive therapy.
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Affiliation(s)
- Janet Leath Alexander
- University of Maryland, Baltimore, Maryland; Children's National Medical Center, Washington, DC.
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Immune recovery uveitis: pathogenesis, clinical symptoms, and treatment. Mediators Inflamm 2014; 2014:971417. [PMID: 25089078 PMCID: PMC4096001 DOI: 10.1155/2014/971417] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/10/2014] [Indexed: 12/13/2022] Open
Abstract
IRU is the most common form of immune reconstitution inflammatory syndrome in HIV-infected patients with cytomegalovirus retinitis who are receiving highly active antiretroviral therapy (HAART). Among patients with CMV in the HAART era, immune recovery may be associated with a greater number of inflammatory complications, including macular edema and epiretinal membrane formation. Given the range of ocular manifestations of HIV, routine ocular examinations and screening for visual loss are recommended in patients with CD4 counts <50 cells/μL. With the increasing longevity of these patients due to the use of HAART, treatment of IRU may become an issue in the future. The aim of this paper is to review the current literature concerning immune recovery uveitis. The definition, epidemiology, pathophysiology, clinical findings, complications, diagnosis, and treatment are presented.
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