1
|
Burgess FR, Peden R, Thum C, Kirby A, Oniscu A, McKenzie K, Simpson L, Chan T. Malignant rhabdoid tumor of the orbit in an infant. J AAPOS 2024:103935. [PMID: 38754729 DOI: 10.1016/j.jaapos.2024.103935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/30/2023] [Revised: 02/29/2024] [Accepted: 03/10/2024] [Indexed: 05/18/2024]
Abstract
We present the case of an infant with rapidly progressing orbital tumor that had initial radiological and clinical features of both rhabdomyosarcoma and capillary hemangioma. The patient was eventually diagnosed with malignant rhabdoid tumor of the orbit. We discuss the salient histological and radiological features of our case and review the literature on orbital malignant rhabdoid tumors.
Collapse
Affiliation(s)
- Frederick R Burgess
- Ophthalmology Department, Royal Hospital for Children & Young People, Edinburgh, United Kingdom;; Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom;; School of Medicine, University of St Andrews, St Andrews, United Kingdom,.
| | - Robert Peden
- Ophthalmology Department, Royal Hospital for Children & Young People, Edinburgh, United Kingdom;; Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
| | - Chee Thum
- Pathology Department, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Andrew Kirby
- Radiology Department, Royal Hospital for Children & Young People, Edinburgh, United Kingdom
| | - Anca Oniscu
- Pathology Department, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Kathryn McKenzie
- Pathology Department, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Lesley Simpson
- Paediatric Oncology Department, Royal Hospital for Children & Young People, Edinburgh, United Kingdom
| | - Tin Chan
- Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
| |
Collapse
|
2
|
Dewdney CJ, Anderson JJ, Dewar S, Doubal F, Burgess FR, Subedi D, Lyall MJ. A case of Lemierre's syndrome causing panhypopituitarism, cavernous sinus thrombosis, ischaemic stroke and pulmonary embolism. J R Coll Physicians Edinb 2023; 53:258-262. [PMID: 37675957 DOI: 10.1177/14782715231198180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Infection is a rare cause of panhypopituitarism and has not been reported in the context of Lemierre's syndrome. We present the case of a previously well 19-year-old man, who presented acutely unwell with meningitis and sepsis. Fusobacterium necrophorum was isolated from peripheral blood cultures and identified on cerebrospinal fluid with 16S rDNA Polymerase Chain Reaction (PCR). Imaging demonstrated internal jugular vein thrombosis with subsequent cavernous venous sinus thrombosis. Pituitary function tests were suggestive of panhypopituitarism. The patient was diagnosed with Lemierre's syndrome complicated by meningitis, cavernous sinus thrombosis, base of skull osteomyelitis, ischaemic stroke and panhypopituitarism. He was treated with 13 weeks of intravenous antibiotics followed by 3 weeks of oral amoxicillin, and anticoagulated with dalteparin then apixaban. His panhypopituitarism was managed with hydrocortisone, levothyroxine and desmopressin.
Collapse
Affiliation(s)
| | | | - Simon Dewar
- Department of Medical Microbiology, NHS Lothian, Edinburgh, UK
| | - Fergus Doubal
- Centre for Clinical Brain Sciences, Edinburgh Neuroscience, Edinburgh, UK
| | | | - Deepak Subedi
- Department of Radiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Marcus J Lyall
- Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian, Edinburgh, UK
| |
Collapse
|
3
|
Burgess FR, Hall HN, Megaw R. Emerging Gene Manipulation Strategies for the Treatment of Monogenic Eye Disease. Asia Pac J Ophthalmol (Phila) 2022; 11:380-391. [PMID: 36041151 DOI: 10.1097/apo.0000000000000545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/27/2022] [Indexed: 12/15/2022] Open
Abstract
Genetic eye diseases, representing a wide spectrum of simple and complex conditions, are one of the leading causes of visual loss in children and working adults, and progress in the field has led to changes in disease investigation, diagnosis, and management. The past 15 years have seen the emergence of novel therapies for these previously untreatable conditions to the extent that we now have a licensed therapy for one form of genetic eye disease and many more in clinical trial. This is a systematic review of published and ongoing clinical trials of gene therapies for monogenic eye diseases. Databases of clinical trials and the published literature were searched for interventional studies of gene therapies for eye diseases. Standard methodological procedures were used to assess the relevance of search results. A total of 59 registered clinical trials are referenced, showing the significant level of interest in the potential for translation of these therapies from bench to bedside. The breadth of therapy design is encouraging, providing multiple possible therapeutic mechanisms. Some fundamental questions regarding gene therapy for genetic eye diseases remain, such as optimal dosing, the relative benefits of adeno-associated virus (AAV)-packaging and the potential for a significant inflammatory response to the therapy itself. As a result, despite the promise of the eye as a target, it has proven difficult to deliver clinically effective gene therapies to the eye. Despite setbacks, the licensing of Luxturna (voretigene neparvovec, Novartis) for the treatment of RPE65-mediated Leber congenital amaurosis (LCA) is a major advance in efforts to treat these rare, but devastating, causes of visual loss.
Collapse
Affiliation(s)
- Frederick R Burgess
- Princess Alexandra Eye Pavilion, NHS Lothian, UK
- Ophthalmology Department, School of Medicine, University of St Andrews, UK
| | - Hildegard Nikki Hall
- Princess Alexandra Eye Pavilion, NHS Lothian, UK
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, UK
| | - Roly Megaw
- Princess Alexandra Eye Pavilion, NHS Lothian, UK
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, UK
| |
Collapse
|
4
|
Fernandes PM, Kinton L, Madill S, Burgess FR, McRorie E, Dhaun N, Kidd D, Lachmann HJ, Davenport RJ, Hunt D. Visual loss with chronic meningeal and systemic inflammation. Pract Neurol 2021. [DOI: 10.1136/practneurol-2021-003066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A 46-year-old man presented with worsening vision in the context of long-standing optic disc changes, bilateral sensorineural hearing loss, chronic aseptic meningitis, rash, arthralgia and raised inflammatory markers. The differential diagnoses of neoplasia, infection and inflammation are discussed. We highlight a condition that can present to adult neurologists, with successful diagnosis leading to targeted treatments that transform patient outcomes. This case was presented at the Association of British Neurologists Annual Meeting 2020 as a Clinicopathological Conference (CPC).
Collapse
|
5
|
Burgess FR, Carroll N, Young SL, Schmoll C, Lampe AK, Chan J. A short-sighted approach to high myopia-not just an eye problem. J AAPOS 2021; 25:247-248. [PMID: 34166818 DOI: 10.1016/j.jaapos.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/16/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022]
Abstract
We present the first case of rapid onset high myopia in early childhood as the presenting feature of Loeys-Dietz syndrome. The patient progressed from a normal degree of hyperopia (+2 diopter sphere [DS]) at 18 months of age to high myopia (-10 DS) 9 months later. Subsequent genetic testing revealed both her brothers and her father to carry the same TGFB3 pathogenic variant. This case aims to highlight the importance of considering systemic conditions in children with high myopia.
Collapse
Affiliation(s)
- Frederick R Burgess
- Department of Ophthalmology, School of Medicine, University of St Andrews; Princess Alexandra Eye Pavilion, Edinburgh.
| | - Nicola Carroll
- South East of Scotland Clinical Genetic Service, Western General Hospital, Edinburgh
| | | | | | - Anne Katrin Lampe
- South East of Scotland Clinical Genetic Service, Western General Hospital, Edinburgh
| | | |
Collapse
|
6
|
Burgess FR, Dhalla K, Mhina CF, Blaikie A. Normative data for peripapillary retinal nerve fibre layer OCT scans in patients of African descent. Eye (Lond) 2020; 35:2646-2647. [PMID: 32918043 DOI: 10.1038/s41433-020-01180-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Frederick R Burgess
- Department of Global Health, School of Medicine, University of St Andrews, St Andrews, UK. .,Department of Ophthalmology, Princess Alexandra Eye Pavilion, Edinburgh, UK.
| | - Kazim Dhalla
- Dr Agarwal's Eye Hospital, Dar es Salaam, Tanzania
| | - Celina F Mhina
- Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Andrew Blaikie
- Department of Global Health, School of Medicine, University of St Andrews, St Andrews, UK
| |
Collapse
|
7
|
Beck D, Galea M, Loo CY, Schmoll C, Burgess FR, Montgomery D, Tatham AJ. Paediatric glaucoma in Scotland. BMC Ophthalmol 2020; 20:76. [PMID: 32103740 PMCID: PMC7045400 DOI: 10.1186/s12886-020-01347-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The primary aim was to estimate the incidence of primary and secondary childhood glaucoma in Scotland over a 2-year period. The secondary aim was to gauge the confidence and experience of ophthalmologists in Scotland in managing these patients. METHODS A 7 question electronic survey was distributed to all consultant members of the Scottish Paediatric Club and Scottish Glaucoma Club. Respondents were asked to report the number of cases and types of childhood glaucoma they had managed in the last 2 years. Respondents were also asked about experience and confidence in a range of glaucoma procedures, number of patients requiring referral to specialist centres and interest in the development of a centre of excellence in Scotland. RESULTS The survey returned a 56% response rate, reporting 85 new cases of paediatric glaucoma in Scotland over the preceding 2 years. 11 (12.9%) had primary glaucoma and 74 (87.1%) had secondary glaucoma. The most common subtype of secondary glaucoma was uveitic glaucoma (n = 29). None of the respondents declared confidence or experience in trabeculotomy or goniotomy procedures. Eleven children required referral to a specialist unit outside Scotland. 85.7% of respondents felt Scotland would benefit from a specialist unit for paediatric glaucoma. CONCLUSIONS This survey reflects an appetite for a specialist service for paediatric glaucoma in Scotland. However, further consideration is needed to determine if there is sufficient patient load to maintain such a service.
Collapse
Affiliation(s)
- Daniel Beck
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK
| | - Martin Galea
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK.,Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053, Great Western Road, Glasgow, G12 0YN, UK
| | - Cheng Yi Loo
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK
| | - Conrad Schmoll
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK
| | - Frederick R Burgess
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK. .,University of St Andrews School of Medicine, North Haugh, St Andrews, Fife, KY16 9TF, UK.
| | - Donald Montgomery
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053, Great Western Road, Glasgow, G12 0YN, UK
| | - Andrew J Tatham
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK
| |
Collapse
|
8
|
Beck DER, Burgess FR, Schmoll CLL. Bilateral cataracts as the presenting feature of type 1 diabetes in an 11-year-old girl. BMJ Case Rep 2018; 2018:bcr-2018-225644. [PMID: 30115719 PMCID: PMC6101330 DOI: 10.1136/bcr-2018-225644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 11/03/2022] Open
Abstract
Paediatric cataracts can present a diagnostic dilemma to ophthalmologists. Next-generation DNA sequencing (NGS) has been promoted as a tool to expedite the diagnosis of an underlying cause in such cases.1 The authors present an unusual case of bilateral cataracts in an 11-year-old girl as the first presenting feature of new type 1 diabetes mellitus. Prompt diagnosis and subsequent management of this potentially life-threatening condition were achieved through careful history taking and targeted biochemical testing. The authors feel this case highlights the significance of simple measures such as thorough history taking in the assessment of paediatric cataracts. It is important that these skills are not lost through the availability of clinical tools such as NGS.
Collapse
|