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Carrubba S, Geevarghese A, Solli E, Guttha S, Sims J, Sperber L, Meehan S, Ostrovsky A. Novel severe oculocutaneous manifestations of human monkeypox virus infection and their historical analogues. Lancet Infect Dis 2023; 23:e190-e197. [PMID: 36702137 PMCID: PMC9870321 DOI: 10.1016/s1473-3099(22)00869-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 01/25/2023]
Abstract
WHO has declared human mpox (formerly known as monkeypox) a global public health emergency since July, 2022. When case numbers were increasing, so did clinicians' exposures to new elements of the disease. Additionally, the burden of mpox is particularly apparent in immunocompromised patients, who can have more variable and severe manifestations of disease across organ systems. In this Grand Round, we report novel and severe oculocutaneous manifestations of mpox in this population, which are both sight and life threatening. Specifically, we highlight two patients with mpox and AIDS who had refractory skin necrosis that progressed to either ocular compromise or panfacial gangrene, or both. Both patients ultimately died due to systemic complications of their infections. Through clinical analogies, we show how past experiences with related orthopoxviruses, such as variola virus (smallpox) and vaccinia virus, can add useful context for understanding and treating these new disease states. We suspect that in patients who are immunocompromised, monkeypox virus can clinically evolve not only via viraemia but also through direct intradermal spread. We propose that intradermal spread occurs by a process clinically and immunologically analogous to progressive vaccinia, a complication previously seen after conventional smallpox vaccination. We share evidence in support of this theory and implications regarding early management and post-exposure prophylaxis for at-risk populations. Content note: this Grand Round contains graphic images of mpox lesions of the eyes and face.
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Affiliation(s)
- Steven Carrubba
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Alexi Geevarghese
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Elena Solli
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Samyuktha Guttha
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Jeffrey Sims
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Laurence Sperber
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Shane Meehan
- Department of Dermatology, NYU Langone Medical Center, New York, NY, USA
| | - Ann Ostrovsky
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA,Correspondence to: Dr Ann Ostrovsky, New York, NY 10017, USA
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Kindschuh M, Radeos M, Lee B, Jeong J, Yap W, Ostrovsky A, Calandro D, Juliano P. 73 Reducing Door-to-Provider Time By Creating a Triage Liaison Physician Line in an Urban Emergency Department During the COVID-19 Pandemic. Ann Emerg Med 2021. [PMCID: PMC8335512 DOI: 10.1016/j.annemergmed.2021.07.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Raab EL, Ackert JM, Ostrovsky A. Rectus muscle flap tear as an independent cause of restricted motility. J AAPOS 2012; 16:386-8. [PMID: 22824495 DOI: 10.1016/j.jaapos.2012.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 03/06/2012] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
Most published cases of rectus muscle flap tear have been associated with orbital trauma of various degrees of severity. When they accompany an orbital fracture, however, it is difficult to determine whether the flap tear is merely an incidental additional finding or a major contributing cause of the resulting restriction. How to treat the flap itself remains an open question. We report a 24-year-old man with an inferior rectus muscle flap tear caused by direct laceration of the muscle. The major finding was a "reverse leash" vertical restriction. Discarding the flap instead of reattaching it did not prevent a successful result. Our case supports the proposition that rectus muscle flap tear can be a restriction-producing entity.
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Affiliation(s)
- Edward L Raab
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York, USA.
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Abstract
An 80-year-old woman presented with signs and symptoms consistent with bilateral nasolacrimal duct obstruction. She also was noted to have multiple eyelid margin lesions. She underwent bilateral dacryocystorhinostomy with biopsy of the nasolacrimal ducts and eyelid lesions. Her tearing resolved. Histopathology of the eyelid lesions was consistent with lipoid proteinosis. Nasolacrimal duct obstruction may occur in patients with lipoid proteinosis (Urbach-Wiethe syndrome).
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Mosse D, Cance M, Steinschaden K, Chartier M, Ostrovsky A, Simoen JP. Determination du rendement du dosimetre au sulfate ferreux dans un faisceau d'electrons de 35 MeV. Phys Med Biol 2000. [DOI: 10.1088/0031-9155/27/4/009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Levine EM, Close J, Fero M, Ostrovsky A, Reh TA. p27(Kip1) regulates cell cycle withdrawal of late multipotent progenitor cells in the mammalian retina. Dev Biol 2000; 219:299-314. [PMID: 10694424 DOI: 10.1006/dbio.2000.9622] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The cyclin-dependent kinase inhibitor protein, p27(Kip1), is necessary for the timing of cell cycle withdrawal that precedes terminal differentiation in oligodendrocytes of the optic nerve. Although p27(Kip1) is widely expressed in the developing central nervous system, it is not known whether this protein has a similar role in neuronal differentiation. To address this issue, we have examined the expression and function of p27(Kip1) in the developing retina, a well-characterized part of the central nervous system. p27(Kip1) is expressed in a pattern coincident with the onset of differentiation of most retinal cell types. In vitro analyses show that p27(Kip1) accumulation in retinal cells correlates with cell cycle withdrawal and differentiation, and when overexpressed, p27(Kip1) inhibits proliferation of the progenitor cells. Furthermore, the histogenesis of photoreceptors and Müller glia is extended in the retina of p27(Kip1)-deficient mice. Finally, we examined the adult retinal dysplasia in p27(Kip1)-deficient mice with cell-type-specific markers. Contrary to previous suggestions that the dysplasia is caused by excess production of photoreceptors, we suggest that the dysplasia is due to the displacement of reactive Müller glia into the layer of photoreceptor outer segments. These results demonstrate that p27(Kip1) is part of the molecular mechanism that controls the decision of multipotent central nervous system progenitors to withdraw from the cell cycle. Second, postmitotic Müller glia have a novel and intrinsic requirement for p27(Kip1) in maintaining their differentiated state.
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Affiliation(s)
- E M Levine
- Department of Biological Structure, University of Washington, Seattle, Washington, 98195, USA.
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