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Maghsoudlou P, Abraham AR, El-Ashry M, Chew C, Mohd N, Ramanan AV, Dick AD. Uveitis Associated with Monogenic Autoinflammatory Syndromes in Children. Ocul Immunol Inflamm 2023; 31:1930-1943. [PMID: 38051595 PMCID: PMC11166052 DOI: 10.1080/09273948.2023.2282610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023]
Abstract
Monogenic autoinflammatory syndromes (MAISs), are caused by pathogenic genetic variants in the innate immune system, leading to dysregulation and aberrant inflammasome activation spontaneously or with minimal triggering. The diagnosis and treatment of MAISs can be intricate, relying on an increased recognition of potential differential diagnoses. This review examines the clinical features of MAIS, with a special focus on uveitis. It also evaluates treatment options and assesses the effects of activating molecular and cytokine pathways.
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Affiliation(s)
- P Maghsoudlou
- Academic Unit of Ophthalmology, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A R Abraham
- Academic Unit of Ophthalmology, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - M El-Ashry
- Department of Paediatric Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - C Chew
- Department of Paediatric Rheumatology, University of Bristol, Bristol, UK
- School of Cellular and Molecular Medicine, University of Bristol, University Walk, Bristol, UK
| | - N Mohd
- Department of Paediatric Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - A V Ramanan
- Department of Paediatric Rheumatology, University of Bristol, Bristol, UK
| | - A D Dick
- Academic Unit of Ophthalmology, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- School of Cellular and Molecular Medicine, University of Bristol, University Walk, Bristol, UK
- UCL Institute of Ophthalmology, London, UK
- NIHR - Biomedical Research Centre, Moorfields and UCL - Institute of Ophthalmology, London, UK
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Hamilton J, Milenkovski N, Martin K, Tully E, Peng C, Hayes I. Rare causes of abdominal pain: a primer for the admitting general surgeon. ANZ J Surg 2023; 93:1773-1779. [PMID: 37350226 DOI: 10.1111/ans.18570] [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: 12/18/2022] [Revised: 05/11/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
The broad uptake of the acute surgical unit (ASU) model of surgical care in Australia has resulted in general surgeons becoming increasingly involved in the management of patients with acute abdominal pain (AAP), some of whom will be labelled as having non-specific abdominal pain (NSAP) (Kinnear N, Jolly S, Herath M, et al. The acute surgical unit: An updated systematic review and meta-analysis. review. Int. J. Surg. 2021;94:106109; Lehane CW, Jootun RN, Bennett M, Wong S, Truskett P. Does an acute care surgical model improve the management and outcome of acute cholecystitis? ANZ J. Surg. 2010;80:438-42). NSAP patients lack a clear diagnosis of surgical pathology based on standard clinical, laboratory and imaging work-up, although they may require ASU admission for pain control and assessment. This article provides a review of uncommon conditions, presenting as AAP, that could possibly be mis-labelled as NSAP, with a focus on aspects of the presentation that may aid diagnosis and management including specific demographic features, clinical findings, key investigations and initial treatment priorities for ASU clinicians. Ultimately, most of the conditions discussed will not require surgical intervention, however, they require a diagnosis to be made and initial treatment planning before on-referral to the appropriate specialty. For the on-call general surgeon, some knowledge of these conditions and an index of suspicion are invaluable for the prompt diagnosis and efficient management of these patients.
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Affiliation(s)
- Jordan Hamilton
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nicole Milenkovski
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Katherine Martin
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Emma Tully
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Calvin Peng
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ian Hayes
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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Bulut M, Kutluk O, Gedık B, Ucar U, Bozdogan YC, Sari MH, Cay HF. Evaluation of retinal and optic disc vascular structures in patients with familial Mediterranean fever (FMF) via optical coherence tomography angiography. Int Ophthalmol 2022:10.1007/s10792-022-02613-x. [DOI: 10.1007/s10792-022-02613-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
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Mansour HA, Ozdal PÇ, Kadayifcilar S, Tugal-Tutkun I, Eser-Ozturk H, Yalçındağ FN, Petrushkin H, Chan EW, Belfaiza S, Karadag R, Güngör SG, Parodi MB, Mansour AM. Familial Mediterranean fever associated frosted branch angiitis, retinal vasculitis and vascular occlusion. Eye (Lond) 2022; 36:2157-2162. [PMID: 34725467 PMCID: PMC9581995 DOI: 10.1038/s41433-021-01822-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/27/2021] [Accepted: 10/14/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To analyse the entity of retinal vasculitis, including frosted branch angiitis (FBA), or retina vascular occlusion in patients with familial Mediterranean fever (FMF). METHODS Retrospective collaborative case series using invitation by email to uveitis specialists around the Mediterranean basin. This series was combined with a literature review. Exclusion criteria included infectious diseases, Behçet's disease or other autoimmune diseases. RESULTS A total of 16 patients (21 eyes) had FMF and retinal vasculitis (FBA 11 patients, mild retinal vasculitis 5 patients). The mean age at onset of vasculitis was 29.5 ± 13.4 (range 9-62) with a female to male ratio of 9 to 7. In 19 eyes treated with various forms of corticosteroid and/or immunosuppression, the mean initial spectacle-corrected visual acuity improved from 6/194 to 6/10.5 at the last mean follow-up of 29.0 ± 34.9 months (p < 0.001). The most common FEVR mutations were M680I and M694V. In addition, retinal vascular occlusions included one case of central retinal artery occlusion and one case of branch retinal artery occlusion. CONCLUSION FBA and milder forms of retinal vasculitis are associated with FMF. Therapy involves an increase in colchicine dosage in early cases, a long period of oral corticosteroid, intravitreal dexamethasone implant or periocular corticosteroid in select cases, and combination therapy with systemic immunosuppression in severe cases. FMF needs to be included in the differential diagnosis of retinal vasculitis.
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Affiliation(s)
- Hana A Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | - Pinar Ç Ozdal
- Uveitis and Behçet Disease Service, University of Health Sciences, Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | | | | | - Hilal Eser-Ozturk
- Department of Ophthalmology, Ondokuz Mayıs University, Samsun, Turkey
| | | | - Harry Petrushkin
- Uveitis and Scleritis Service, Moorfields Eye Hospital, London, UK
- Pediatric Uveitis Service, Great Ormond St Hospital, London, UK
| | - Errol W Chan
- Department of Ophthalmology and Visual Sciences, McGill University, Montreal, Canada
- Department of Ophthalmology, National University Health System, Singapore, Thailand
| | - Soukaina Belfaiza
- Department of Ophthalmology, Mohammed V Military Hospital, Rabat, Morocco
| | - Remzi Karadag
- RK Eye, Aesthetic and Health Services, Kadikoy, Istanbul, Turkey
- Veni Vidi Eye Center, Caddebostan, Kadikoy, Istanbul, Turkey
| | | | | | - Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.
- Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon.
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Vofo BN, Amer R. Outer Retina Rupture from Subretinal Blood with Spontaneous Sealing and Visual Recovery in Frosted Branch Angiitis from Familial Mediterranean Fever: A Case Report. Turk J Ophthalmol 2022; 52:286-290. [PMID: 36017544 PMCID: PMC9421930 DOI: 10.4274/tjo.galenos.2022.69337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Familial Mediterranean fever (FMF) is a rare autoinflammatory disorder. Ocular involvement is rare. The full spectrum and response to treatment is poorly understood. An 18-year-old girl previously diagnosed with FMF presented with sudden loss of vision in the left eye (LE). Best-corrected visual acuity (BCVA) in the LE was finger counting at 1.5 meters. Angiitis with mild “frosting,” hemi-central retinal vein occlusion (HCRVO), and acute outer retina rupture (ORR) were observed in the LE. Systemic steroids were initiated immediately. The ORR was sealed 2 weeks later while vision improved to 6/15 (near vision: J2) 5 months later. No recurrences were observed over 5 years of follow-up. We report a rare manifestation of frosted branch angiitis with concomitant HCRVO and ORR in a young patient with FMF. Closure of ORR was attained and vision recovered after treatment with high-dose steroids.
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Ocular blood flow and retinal, choroidal, and retinal nerve fiber layer thickness in children with familial Mediterranean fever with at least five attacks. Int Ophthalmol 2022; 42:3109-3116. [PMID: 35511318 DOI: 10.1007/s10792-022-02310-9] [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: 11/20/2021] [Accepted: 04/17/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to evaluate ocular blood flow and, retinal, choroidal and retinal nerve fiber layer thickness in children with familial Mediterranean fever (FMF) with patients who had at least five attacks. METHODS Fifty-six patients with FMF and 56 healthy subjects were enrolled in the study. Each participant's choroidal thickness (CT) and retinal thickness (RT) measurements were performed in the foveola and at horizontal nasal and temporal quadrants within 500-μm intervals up to 1.500 μm from the foveola using spectral-domain optical coherence tomography as well as the retinal nerve fiber layer thickness (RNFLT). Disc boundaries were determined manually by identifying seven points on the inner edge of the scleral ring. Following complete ophthalmological evaluation, peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistivity index (RI) values in the central retinal artery (CRA), ophthalmic artery (OA), and nasal posterior ciliary artery (NPCA) were measured using color Doppler ultrasonography (CDU) in the left eyes of the patients diagnosed with FMF and the controls. The results were subsequently compared. RESULTS No statistically significant differences were observed between the groups in terms of all RNFLT quadrant and RT measurements. All CT measurements were thinner in patients with FMF than in the controls (For Central and Temporal_1500 p = 0.01; For Temporal_500, Nasal 500 and Nasal_1000 p < 0.001; Temporal_1000 p = 0.002) except than the Nasal_1500 point. For nasal_1500 p = 0.121). The PSV and EDV values in the OA, CRA, and NPCA were significantly lower in patients with FMF compared to healthy controls (p < 0.001 for all). In contrast, the RI values of all arteries were significantly higher than in the control group (Regarding OA, CRA and NPCA RI, p = 0.003, p = 0.039, and p = 0.039, respectively). CONCLUSIONS The results of this study support the idea that chronic inflammation and frequent attacks in FMF may have an effect on decreased ocular blood flow and choroidal thinning.
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Guo W, Feng X, Hu M, Shangguan Y, Xia J, Hu W, Li X, Zhang Z, Shi Y, Xu K. The Application of Whole-Exome Sequencing in Patients With FUO. Front Cell Infect Microbiol 2022; 11:783568. [PMID: 35096640 PMCID: PMC8790153 DOI: 10.3389/fcimb.2021.783568] [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: 09/26/2021] [Accepted: 12/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background Fever of unknown origin (FUO) is still a challenge for clinicians. Next-generation sequencing technologies, such as whole exome sequencing (WES), can be used to identify genetic defects in patients and assist in diagnosis. In this study, we investigated the application of WES in individuals with FUO. Methods We performed whole-exome sequencing on 15 FUO patients. Clinical information was extracted from the hospital information system. Results In 7/15 samples, we found positive results, including potentially causative mutations across eight different genes: CFTR, CD209, IRF2BP2, ADGRV 1, TYK2, MEFV, THBD and GATA2. Conclusions Our results show that whole-exome sequencing can promote the genetic diagnosis and treatment of patients with FUO.
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Affiliation(s)
- Wanru Guo
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xuewen Feng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ming Hu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yanwan Shangguan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jiafeng Xia
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Wenjuan Hu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaomeng Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zunjing Zhang
- Department of Respiratory Medicine, Lishui Hospital of Traditional Chinese Medicine (TCM), Lishui, China
| | - Yunzhen Shi
- Department of Infectious Diseases,Dongyang People's Hospital, Dongyang, China
| | - Kaijin Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Cardiac Tamponade: A Rare Manifestation of Familial Mediterranean Fever. Case Rep Rheumatol 2022; 2022:8334375. [PMID: 35178266 PMCID: PMC8844152 DOI: 10.1155/2022/8334375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022] Open
Abstract
Familial Mediterranean fever (FMF) typically presents with recurrent attacks of fever and serosal inflammation with peritoneum, pleura, and synovium. We usually do not expect pericardial involvement at the early stages. FMF is an autoinflammatory disease, usually inherited with an autosomal recessive pattern. The patients typically have biallelic mutations in the MEFV gene, located on chromosome 16. Colchicine is the first-line treatment of FMF, which not only plays a crucial prophylactic role regarding the attack episodes, but also prevents amyloidosis. Colchicine resistance and intolerance in FMF patients have been rarely reported. Alternative anti-inflammatory agents are understood to be helpful in such cases. We describe a 13-year-old boy referred to our pediatric department complaining of chest pain, dyspnea, and tachycardia. Due to the massive pericardial and pleural effusion, a pericardiocentesis was performed, and a chest tube was inserted. Cardiac tamponade was considered as the initial diagnosis. After a month, he faced another episode of pleuritic chest pain, fever, tachycardia, and pleural and pericardial effusion. Evaluation for probable differential diagnoses including infection, malignancy, and collagen vascular disease showed no remarkable results. Finally, the mutation found by whole exome sequencing was confirmed by direct Sanger sequencing revealing a heterozygote c.44G > C (p.Glu148Gln) mutation in exon 2, confirming the clinical diagnosis of familial Mediterranean fever. Since he seemed to be nonresponsive to the maximum standard dose of colchicine, 100 mg of daily dapsone was added to his treatment regimen, which controlled the attack episodes well. FMF, while rarely initiated with cardiac manifestation, should be considered in patients with any early signs and symptoms of cardiovascular involvement.
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Bilateral Optic Disc Swelling as a Plausible Common Ocular Sign of Autoinflammatory Diseases: Report of Three Patients with Blau Syndrome or Cryopyrin-Associated Periodic Syndrome. Life (Basel) 2021; 11:life11121433. [PMID: 34947964 PMCID: PMC8709039 DOI: 10.3390/life11121433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/14/2021] [Indexed: 12/29/2022] Open
Abstract
The aim of this study is to describe bilateral optic disc swelling in three consecutive patients with Blau syndrome or cryopyrin-associated periodic syndrome at a single institution. Case 1 was a 30-year-old woman receiving 25 mg etanercept twice weekly who had been diagnosed as early-onset sarcoidosis by biopsy of skin rashes at 5 months old and genetically diagnosed with Blau syndrome with CARD15/NOD2 mutation (N670K) at 13 years old. At 10 years old, she began to have uveitis with optic disc swelling in both eyes, resulting in macular degeneration and optic disc atrophy at 17 years old only when etanercept was introduced. Case 2 was a 21-year-old man receiving adalimumab every 2 weeks who had been diagnosed as early-onset sarcoidosis by biopsy of skin rashes at 1.5 years old and genetically diagnosed as Blau syndrome with CARD15/NOD2 mutation (C495Y) at 5 years old. At 8 years old, around the time of adalimumab introduction, he began to show bilateral optic disc swelling which continued until the age of 16 years when the dose of adalimumab was increased. Case 3 was a 20-year-old woman receiving canakinumab every 8 weeks for systemic symptoms such as fever, headache, vomiting, and abdominal pain and later for sensorineural hearing disturbance on both sides. She had been diagnosed genetically with cryopyrin-associated periodic syndrome with NLRP3 mutation (Y859C) at 7 years old. At 5 years old, she was found to have bilateral optic disc swelling, which continued until the age of 10 years when she began receiving canakinumab (IL-1β inhibitor). Bilateral optic disc swelling might be tentatively designated as a plausible common ocular feature, if it occurred, in autoinflammatory diseases to pay more attention to ophthalmic complications in rare diseases.
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Abouzaid M, Hassib N, Hamed K, Taher M, Sokkar M, Eltaweel N, El-Bassyouni H. Oro-dental features in Egyptian patients with familial mediterranean fever. SPECIAL CARE IN DENTISTRY 2021; 42:376-382. [PMID: 34902169 DOI: 10.1111/scd.12687] [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: 09/09/2021] [Revised: 11/25/2021] [Accepted: 11/28/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Familial Mediterranean fever (FMF) is an episodic inflammatory disease that is inherited as an autosomal recessive trait. It is primarily featured by fever, pain in joints, chest, and abdomen due to Serositis. AIM This study delineated the oro-facial structures presented associated with FMF, as well as, the determination of the potential influences of the long-term inflammatory process of FMF on several oral structures. METHODS Fifty eight Egyptian FMF patients were examined to define different oro-facial structures. Serum amyloid A (SAA) was requested for the selected patients, MEFV gene mutation was also investigated. RESULTS The clinical examination revealed peritonitis in 79%, fever in 63.7%, and arthritis in 55% of FMF patients examined, while, oral features as high arched palate, enamel defect, dental malocclusion, and macroglossia in 32%, 27.5%. 26%, and 13.5%, respectively. The previous symptoms might be attributed to the pathology of the disease. Macroglossia when tested versus SAA levels, a highly significant difference was detected. The ROC curve when examining the SAA value to assess macroglossia, displayed reasonable sensitivity and specificity values of, 87.5% and 77.8%, respectively. CONCLUSION The noticed oro-dental in FMF patients might be influenced by the chronic inflammatory process.
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Affiliation(s)
- Maha Abouzaid
- Oro-dental Genetics department, National Research Centre, Cairo, Egypt
| | - Nehal Hassib
- Oro-dental Genetics department, National Research Centre, Cairo, Egypt
| | - Khaled Hamed
- Clinical Genetics department, National Research Centre, Cairo, Egypt
| | - Mohamed Taher
- Clinical Genetics department, National Research Centre, Cairo, Egypt
| | - Mona Sokkar
- Molecular Genetics and Enzymology department, National Research Centre, Cairo, Egypt
| | - Noha Eltaweel
- Medical Molecular Genetics department, National Research Centre, Cairo, Egypt
| | - Hala El-Bassyouni
- Clinical Genetics department, National Research Centre, Cairo, Egypt
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Ocular inflammatory diseases in children with familial Mediterranean fever: a true association or a coincidence? Int Ophthalmol 2021; 42:1249-1257. [PMID: 34786627 DOI: 10.1007/s10792-021-02111-6] [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: 04/09/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe the characteristics of patients with familial Mediterranean fever (FMF) with concurrent ocular inflammatory disease (OID) and to analyze possible relations between them. METHODS Clinical data were extracted from electronic medical records. Additionally, the medical literature on OIDs reported in patients with FMF was reviewed. RESULTS Among 512 pediatric patients with FMF, five cases were found to have OIDs: bilateral anterior chronic uveitis, bilateral panuveitis, recurrent optic neuritis (RON), recurrent orbital myositis (ROM), and acquired Brown's syndrome. The first cases of ROM and acquired Brown's syndrome in FMF have been described in the literature. All cases presented with early-onset typical FMF attacks, carried at least one M694V mutation, and experienced OID while on colchicine. CONCLUSION Increased frequency of OIDs in FMF as per the pediatric population and relapsing and chronic course of OIDs occasionally with concurrent FMF attacks suggest that this inflammatory syndrome, especially those carrying M694V mutations, may be a predisposing factor for OIDs.
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ELBEYLİ A. The Effect of Familial Mediterranean Fever Disease on The Cornea. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2021. [DOI: 10.17944/mkutfd.978113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Evaluation of the Ocular Surface, Conjunctival Impression Cytology and Meibomian Gland Dropout in Patients with Familial Mediterranean Fever. J Fr Ophtalmol 2021; 44:1319-1325. [PMID: 34561094 DOI: 10.1016/j.jfo.2021.05.007] [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: 03/04/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Familial Mediterranean fever (FMF) is an idiopathic disease with chronic inflammation. We aimed to determine the changes caused by the chronic inflammatory nature of FMF on the ocular surface, meibomian glands (MG), and conjunctiva via conjunctival impression cytology (CIC). MATERIAL-METHOD Forty-two FMF patients with a mean age of 11.93±3.92 years and 36 control patients with a mean age of 11.83±3.38 years were included in the study. Ocular surface anomalies of the patients were evaluated using Schirmer II, TBUT and OSDI. MG function (meibum quality), morphology (meiboography), and CIC were evaluated. RESULTS Although there was a significant difference between the groups in terms of Schirmer II and TBUT, OSDI scores did not significantly differ (P=0.022, 0.010, and 0.099 respectively), and no significant dry eye sign was observed in either group. There was significant difference between the groups in terms of the percent area of MG dropout, MG density, meiboscore (P=0.020, 0.023, and 0.031 respectively), but no significant difference was observed in relation to MG quality (P=0.650). Although conjunctival impression cytology was of a higher grade in the patients with FMF according to Nelson's classification, no significant difference was observed between the groups (P=0.109). CONCLUSION Although there was a decrease in the number of MGs in FMF patients, no significant deterioration was observed in conjunctival cytology. In these patients, tear film stability may deteriorate in particular. Clinicians should be aware of the possibility of ocular surface disease secondary to MG dropout in patients with FMF.
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Belfaiza S, Zerrouk R, Brarou H, Jeddou I, Abdellaoui T, Mouzari Y, Laasri F, Reda K, Oubaaz A. [Frosted branch angiitis: An uncommon finding in familial Mediterranean fever]. J Fr Ophtalmol 2021; 44:e195-e197. [PMID: 33446349 DOI: 10.1016/j.jfo.2020.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/18/2020] [Accepted: 06/21/2020] [Indexed: 11/17/2022]
Affiliation(s)
- S Belfaiza
- Service d'ophtalmologie, hôpital militaire Mohammed V, 10100 Hay Ryad, Rabat, Maroc.
| | - R Zerrouk
- Service d'ophtalmologie, hôpital militaire Mohammed V, 10100 Hay Ryad, Rabat, Maroc
| | - H Brarou
- Service d'ophtalmologie, hôpital militaire Mohammed V, 10100 Hay Ryad, Rabat, Maroc
| | - I Jeddou
- Service d'ophtalmologie, hôpital militaire Mohammed V, 10100 Hay Ryad, Rabat, Maroc
| | - T Abdellaoui
- Service d'ophtalmologie, hôpital militaire Mohammed V, 10100 Hay Ryad, Rabat, Maroc
| | - Y Mouzari
- Service d'ophtalmologie, hôpital militaire Mohammed V, 10100 Hay Ryad, Rabat, Maroc
| | - F Laasri
- Service d'ophtalmologie, hôpital militaire Mohammed V, 10100 Hay Ryad, Rabat, Maroc
| | - K Reda
- Service d'ophtalmologie, hôpital militaire Mohammed V, 10100 Hay Ryad, Rabat, Maroc
| | - A Oubaaz
- Service d'ophtalmologie, hôpital militaire Mohammed V, 10100 Hay Ryad, Rabat, Maroc
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Rahman N, Petrushkin H, Solebo AL. Paediatric autoimmune and autoinflammatory conditions associated with uveitis. Ther Adv Ophthalmol 2020; 12:2515841420966451. [PMID: 33225212 PMCID: PMC7649876 DOI: 10.1177/2515841420966451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023] Open
Abstract
Childhood uveitis comprises a collection of heterogenous ocular phenotypes which are associated with a diverse range of childhood autoimmune and autoinflammatory disorders. Of these genetic and/or acquired disorders, juvenile idiopathic arthritis is the most common, affecting 30-80% of children with uveitis. Up to a third of children with uveitis have 'isolated' idiopathic disease and do not have an associated systemic disease which manifests in childhood. However, uveitis may be the presenting manifestation of disease; thus, the apparently well child who presents with uveitis may have isolated idiopathic disease, but they may have an evolving systemic disorder. The diagnosis of most of the associated disorders is reliant on clinical features rather than serological or genetic investigations, necessitating detailed medical history taking and systemic examination. Adequate control of inflammation is key to good visual outcomes, and multidisciplinary care is key to good broader health outcomes.
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Affiliation(s)
- Najiha Rahman
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Ameenat Lola Solebo
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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16
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Şaş S, Kurt A, Kurt EE, Koçak FA, Erdem HR. Evaluation of Dry Eye Syndrome in Patients With Familial Mediterranean Fever: A Cross-sectional Study. JOURNAL OF RHEUMATIC DISEASES 2020. [DOI: 10.4078/jrd.2020.27.4.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Senem Şaş
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ali Kurt
- Department of Ophtalmology, Kırşehir Ahi Evran University Faculty of Medicine, Kırşehir, Turkey
| | - Emine Eda Kurt
- Department of Physical Medicine and Rehabilitation, Kırşehir Ahi Evran University Faculty of Medicine, Kırşehir, Turkey
| | - Fatmanur Aybala Koçak
- Department of Physical Medicine and Rehabilitation, Kırşehir Ahi Evran University Faculty of Medicine, Kırşehir, Turkey
| | - Hatice Rana Erdem
- Department of Physical Medicine and Rehabilitation, Kırşehir Ahi Evran University Faculty of Medicine, Kırşehir, Turkey
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17
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Yener A, Tayfur A. Posterior Segment Ocular Parameters in Children with Familial Mediterranean Fever. Ocul Immunol Inflamm 2019; 29:615-620. [PMID: 31850808 DOI: 10.1080/09273948.2019.1695857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To measure and compare posterior ocular layers in remission period in children with familial Mediterranean fever (FMF).Methods: A randomly selected eye and fellow eye of 20 FMF patients and 20 control eyes were evaluated. The average age of patients and control subjects were 12.9 ± 2.7 and 13.4 ± 2.7, respectively (p = .57). Peripapillary retinal nerve fiber layer thickness, optic nerve head parameters, macular ganglion cell inner plexiform layer and ganglion cell complex thickness, foveal and parafoveal vascular densities, superficial/deep foveal avascular zone area and choroidal thickness were measured using swept source optical coherence tomography angiography.Results: Among the overall measurements, temporal quadrant parafoveal vessel density of patients was significantly higher than that of controls (49.20 ± 2.57% vs 47.14 ± 3.17%, p = .04) and nasal quadrant vessel density was lower (42.88 ± 4.13% vs 46.76 ± 3.18%, p = .02).Conclusions: This study indicated that FMF as an autoimmune disease may affect foveal vascular structure in children besides multiple other organ involvement.
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Affiliation(s)
- ArifÜlkü Yener
- Department of Ophthalmology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - AslıÇelebi Tayfur
- Department of Pediatric Nephrology, Keçiören Training and Research Hospital, Ankara, Turkey
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18
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Karaca EE, Ozek D, Omma A, Evren Kemer O. Comparison of optical coherence tomography angiography results of adult patients with Familial Mediterranean fever and healthy individuals. Ther Adv Ophthalmol 2019; 11:2515841419892056. [PMID: 31840134 PMCID: PMC6893935 DOI: 10.1177/2515841419892056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/30/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose The aim of this study is to assess the macular ultrastructure measuring by optical coherence tomography angiography in adult patients with Familial Mediterranean fever. Methods Participants were 62 Familial Mediterranean fever patients and 54 healthy individuals in control group with similar age and sex. The superficial and deep vascular plexus structures covering the central fovea in an area of 6 mm × 6 mm were measured using AngioVue images taken with optical coherence tomography angiography. Vasculature structure, foveal avascular zone, acircularity index of foveal avascular zone (the ratio of the perimeter of foveal avascular zone and the perimeter of a circle with the equal area), and superficial and deep retinal plexus densities were measured. Results The inferior deep vascular density was measured: 49.17% ± 8.59% in Familial Mediterranean fever patients, 55.56% ± 5.92% in the control group. The deep inferior-hemi vascular density was measured: 48.59% ± 10.34% in Familial Mediterranean fever patients, 56.54% ± 8.05% in the control group. Deep inferior and deep inferior-hemi vascular density was significantly reduced in Familial Mediterranean fever patients compared with healthy controls (p = 0.04 and p = 0.03, respectively). Conclusion The vascular abnormalities in optical coherence tomography angiography show subclinical signs of microangiopathy in Familial Mediterranean fever patients. This observation, which can be obtained only through optical coherence tomography angiography, may be an ocular hallmark for Familial Mediterranean fever disease.
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Affiliation(s)
- Emine Esra Karaca
- Department of Ophthalmology, Health Sciences University, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Dilay Ozek
- Department of Ophthalmology, Health Sciences University, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ahmet Omma
- Department of Rheumatology, Health Sciences University, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ozlem Evren Kemer
- Department of Ophthalmology, Health Sciences University, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Rostamizadeh L, Vahedi L, Bahavarnia SR, Alipour S, Abolhasani S, Khabazi A, Sakhinia E. Mediterranean fever (MEFV) gene profile and a novel missense mutation (P313H) in Iranian Azari-Turkish patients. Ann Hum Genet 2019; 84:37-45. [PMID: 31512232 DOI: 10.1111/ahg.12347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/12/2019] [Accepted: 08/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Familial Mediterranean fever (FMF) is common in Azari-Turkish people, one of the biggest ethnic groups in Iran. In this study, we sought to investigate the mutation spectrum of the MEFV gene and any genotype-phenotype correlations. METHODS AND MATERIALS 400 unrelated Azari-Turkish FMF patients were analyzed in this study. Mutations in exons 2, 3, 5, and 10 of the MEFV gene were investigated using direct Sanger sequencing, and their correlations with the clinical features of the patients were analyzed. RESULTS At least one mutation was detected in 248 (62%) patients. The most common mutations were M694V (26.25%) and E148Q (24.75%), respectively. Abdominal pain (65.2%) and fever 204 (51%) were the most frequent clinical problems in all subjects. The analysis recognized a novel missense mutation in the coding region of the MEFV gene, named P313H, which is the first report of a new mutation in exon 2 of the MEFV gene in an Azari-Turkish family. CONCLUSION Genotype-phenotype correlations obtained from this study would be helpful in the diagnosis and management of FMF patients in clinical situations. This novel missense mutation may provide useful evidence for further studies of FMF pathogenesis.
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Affiliation(s)
- Leila Rostamizadeh
- Department of Molecular Medicine, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Vahedi
- Liver and Gastrointestinal Disease Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Shahriar Alipour
- Department of Molecular Medicine, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Somayeh Abolhasani
- Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Khabazi
- Connective Tissue Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ebrahim Sakhinia
- Department of Genetics, Faculty of Medical Sciences , Tabriz University of Medical Sciences, Tabriz, Iran
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Mansour AM, Khatib L, Mansour HA. Posterior Scleritis in Familial Mediterranean Fever. Case Rep Ophthalmol 2019; 10:134-139. [PMID: 32231554 PMCID: PMC7098358 DOI: 10.1159/000499600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/13/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose Familial Mediterranean fever (FMF) is a monogenic autoinflammatory disease presenting as sporadic paroxysmal attacks of fever and abdominal pain. The inflammation of serosal spaces, joints, and skin is caused by the production of an abnormal protein called pyrin. Ocular pathology is scarce in FMF. Case Report Herein we describe a case of FMF presenting with painful loss of vision in the left eye. Serous macular detachment assessed by OCT, leaky pinpoint subretinal foci temporal to the fovea examined by fluorescein angiography, scleral and choroidal thickening seen on ultrasonography, and a negative systemic workup for vasculitis established the diagnosis of FMF-related posterior scleritis. The posterior scleritis responded promptly to moderate-dose oral corticosteroids with return of vision to baseline and resolution of the subretinal fluid. Conclusions FMF rarely involves the posterior pole. Visual loss in FMF results from either posterior scleritis or posterior uveitis. A high degree of suspicion of posterior scleritis is warranted in female patients with known FMF presenting with cloudy serous macular detachment.
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Affiliation(s)
- Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.,Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon
| | - Lama Khatib
- Department of Ophthalmology, Clemenceau Medical Center, Beirut, Lebanon
| | - Hana A Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
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21
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Abstract
Purpose: To present the ocular findings of the members of a family that has the diagnosis of Muckle Wells syndrome, a form of cryopyrin associated periodic syndrome (CAPS).Materials and Methods: Nine patients with MWS were included in this study. Each study participant underwent a systemic evaluation, comprehensive ophthalmic examination, and auxillary testings.Results: In this study, conjunctivitis was the most prominent ocular finding. Other relatively common ocular findings included band keratopathy, clinical signs of past uveitis, and corneal topography abnormalities. Nystagmus, corneal leukoma, and optic nerve pallor with epiretinal membrane were also detected. Rare ocular manifestations were posterior stromal corneal opacification with edema, anterior iris snychecia, and mild cataract.Conclusion: MWS is a rare systemic autoinflammatory disorder that presents with a variety of ocular findings. Exacerbation of systemic and ocular findings with cold is a hallmark of the disease.
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Affiliation(s)
- Sukru Cekic
- Pediatric Allergy and Clinical Immunology, Uludag University School of Medicine, Bursa, Turkey
| | - Ozgur Yalcinbayir
- Department of Ophthalmology, Uludag University School of Medicine, Bursa, Turkey
| | - Sara Sebnem Kilic
- Pediatric Allergy and Clinical Immunology, Uludag University School of Medicine, Bursa, Turkey
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Cunningham ET, Smith JR, Tugal-Tutkun I, Rothova A, Zierhut M. Uveitis in Children and Adolescents. Ocul Immunol Inflamm 2017; 24:365-71. [PMID: 27471956 DOI: 10.1080/09273948.2016.1204777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Emmett T Cunningham
- a Department of Ophthalmology , California Pacific Medical Center , San Francisco , California , USA.,b The Department of Ophthalmology , Stanford University School of Medicine , Stanford , California , USA.,c The Francis I. Proctor Foundation , UCSF School of Medicine , San Francisco , California , USA
| | - Justine R Smith
- d Eye & Vision Health , Flinders University School of Medicine , Adelaide , South Australia , Australia
| | - Ilknur Tugal-Tutkun
- e Department of Ophthalmology , Istanbul Faculty of Medicine, Istanbul University , Istanbul , Turkey
| | - Aniki Rothova
- f Department of Ophthalmology ; Erasmus Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Manfred Zierhut
- g Centre for Ophthalmology , University Tuebingen , Tuebingen , Germany
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23
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Frosted Branch Angiitis Secondary to Familial Mediterranean Fever Resembling Central Retinal Vein Occlusion. Case Rep Ophthalmol Med 2017; 2016:2916027. [PMID: 28044118 PMCID: PMC5164904 DOI: 10.1155/2016/2916027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/13/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose. To report a case of unilateral frosted branch angiitis (FBA) resembling central retinal vein occlusion associated with Familial Mediterranean Fever (FMF). Case Report. A 32-year-old woman presented with progressive, painless vision loss in her left eye lasting for 2 days. She was clinically diagnosed with FMF 2 months ago. The best-corrected visual acuity (BCVA) was 20/20 in her right eye and there was light perception in the left. Ophthalmologic examination revealed severe retinal vasculitis showing clinical features of FBA in the left eye. 64 mg/day oral methylprednisolone was started. A significant improvement in retinal vasculitis was observed in two weeks. However, BCVA did not increase significantly due to subhyaloid premacular hemorrhage. Argon laser posterior hyaloidotomy was performed. One week after hyaloidotomy, visual acuity improved to 20/20 and intravitreal hemorrhage disappeared. Four months after the first attack, FBA recurred. Oral methylprednisolone dosage was increased to 64 mg/day and combined with azathioprine 150 mg. At the end of 12-month follow-up, the BCVA was 20/25 and development of epiretinal membrane was observed in the left eye. Conclusions. Frosted branch angiitis may occur with gene abnormalities as an underlying condition. Our case showed that FMF might be a causative disease.
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24
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Mozdiak E, Akhtar J, Gowda R, Arasaradnam R. Familial mediterranean fever-anticipated rise in Western Europe. QJM 2016; 109:485-6. [PMID: 27083983 DOI: 10.1093/qjmed/hcw059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Mozdiak
- From the Department of Gastroenterology, University Hospital Coventry, Warwickshire, UK
| | - J Akhtar
- From the Department of Gastroenterology, University Hospital Coventry, Warwickshire, UK
| | - R Gowda
- Department of Infectious Diseases, University Hospital Coventry & Warwickshire, UK
| | - R Arasaradnam
- From the Department of Gastroenterology, University Hospital Coventry, Warwickshire, UK Clinical Sciences Research Institute, University Hospital Coventry & Warwickshire & University of Warwick, UK
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