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Karube D, Kamiya K, Sugihara N, Maekawa T, Komine M, Ohtsuki M. A case of bilateral dacryocystitis caused by Streptococcus constellatus and Actinomyces israelii. J Dermatol 2024; 51:e135-e136. [PMID: 37997462 DOI: 10.1111/1346-8138.17041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/15/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Daiki Karube
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Koji Kamiya
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Natsuko Sugihara
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Mayumi Komine
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Boal NS, Chiou CA, Sadlak N, Sarmiento VA, Lefebvre DR, Distefano AG. Antibiotic utilization in endoscopic dacryocystorhinostomy: a multi-institutional study and review of the literature. Orbit 2024; 43:183-189. [PMID: 37395439 DOI: 10.1080/01676830.2023.2227705] [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] [Received: 02/12/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Utilization of antibiotics for endoscopic dacryocystorhinostomy (endo-DCR) is largely dependent on individual surgeon preference. This study aimed to investigate prescribing practices of pre-, peri-, and postoperative antibiotics and effects on postoperative infection rates in patients who underwent endo-DCR. METHODS A retrospective chart review of institutional data at two academic centers of endo-DCR cases from 2015-2020 was performed. Postoperative infection rates for patients who received pre-, peri-, and postoperative antibiotics, individually or in combination, and those who did not, were compared via odds ratio and ANOVA linear regression. RESULTS 331 endo-DCR cases were included; 22 cases (6.6%) had a postoperative infection. There was no significant difference in the infection rates between patients without an active preoperative dacryocystitis who received different permutations of peri- and postoperative antibiotics. Patients who received preoperative antibiotics within two weeks of surgery for preexisting acute dacryocystitis, but did not receive peri- or postoperative antibiotics, had a higher rate of postoperative infections (p = 008). CONCLUSIONS Our data suggest antibiotics may be beneficial only when patients have a recent or active dacryocystitis prior to surgery. Otherwise, our data do not support the routine use of antibiotic prophylaxis in endo-DCR.
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Affiliation(s)
- Nina S Boal
- Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Carolina A Chiou
- Division of Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie Sadlak
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - V Adrian Sarmiento
- Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Daniel R Lefebvre
- Division of Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Division of Ophthalmology, Surgical Service, Boston Veterans Affairs HealthCare System, Boston, Massachusetts, USA
- Dedham Ophthalmic Consultants and Surgeons / Lexington Eye Associates, Dedham, Massachusetts, USA
| | - Alberto G Distefano
- Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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Tian X, Sun H, Huang Y, Sui W, Zhang D, Sun Y, Jin J, He Y, Lu X. Microbiological isolates and associated complications of dacryocystitis and canaliculitis in a prominent tertiary ophthalmic teaching hospital in northern China. BMC Ophthalmol 2024; 24:56. [PMID: 38317063 PMCID: PMC10840201 DOI: 10.1186/s12886-024-03323-x] [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] [Received: 05/25/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND To report the microbiological isolates, aetiology, complications, antibiotic susceptibilities, and clinical remission of dacryocystitis and canaliculitis in a prominent tertiary ophthalmic teaching and referral hospital located in northern China and to offer appropriate recommendations for preventing and formulating drug treatment strategies. METHODS This prospective study recruited a total of 477 participants who had been diagnosed with either dacryocystitis or canaliculitis. The cohort comprised 307 patients with chronic dacryocystitis, 111 patients with acute dacryocystitis, and 59 patients with canaliculitis. Purulent discharge from the lacrimal duct was collected using a sterile swab and immediately subjected to microbial culture. Antimicrobial susceptibility testing was conducted following established protocols. All participants were scheduled for follow-up visits within 14 days after receiving antibiotic therapy. RESULTS The present findings indicated that women exhibited a higher susceptibility to the condition, as evidenced by the occurrence of 367 cases in comparison to 110 cases among men. Among the 477 patients, definitive causes were established in 59 individuals, accounting for 12.4% of the patients. Additionally, ocular complications were reported by 132 patients, representing 27.7% of the total. Monocular involvement was observed in the majority of cases, with 402 out of 477 patients (84.3%) affected, while binocular involvement was present in 75 patients (15.7%). In total, 506 microbiological strains were recovered from 552 eyes, with Staphylococcus epidermidis (16.4%) being the most prevalent microorganism. Other predominant isolates included Corynebacterium macginleyi (9.1%), Staphylococcus aureus (5.1%), Streptococcus pneumoniae (4.9%), Haemophilus (4.4%), Propionibacterium acnes (3.5%), and Eikenella corrodens (3.1%). Among the 12 isolated fungi, Candida parapsilosis accounted for 66.7%. The susceptibility to antimicrobial agents tested in gram-negative bacilli (79.5%) was observed to be higher than that of anaerobic bacteria (76.7%) and gram-positive cocci (55.4%). With pharmacological therapy, the remission rate of acute dacryocystitis (72.7%) was found to be higher than that of canaliculitis (53.3%) and chronic dacryocystitis (42.3%). CONCLUSIONS This study highlights the microbial spectrum of dacryocystitis and canaliculitis, particularly C.macginleyi, E.corrodens and C.parapsilosis, which are also more frequently isolated. Vancomycin and imipenem may be more effective treatment options. Most cases have an unknown aetiology, and essential preventive measures involve postoperative cleansing of the lacrimal passage following eye and nasal surgeries, as well as the proactive management of rhinitis.
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Affiliation(s)
- Xiaobo Tian
- Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, China
| | - Hua Sun
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, China
| | - Yanfei Huang
- Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, China
| | - Wenjun Sui
- Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, China
| | - Dan Zhang
- Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, China
| | - Yufeng Sun
- Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, China
| | - Jing Jin
- Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, China
| | - Yueqing He
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, China
| | - Xinxin Lu
- Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, China.
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Suenaga A, Sawa N, Oba Y, Ikuma D, Sekine A, Yamanouchi M, Hasegawa E, Mizuno H, Suwabe T, Tsuji H, Kono K, Kinowaki K, Miyazono M, Yamaguchi Y, Ubara Y. Immunoglobulin G4-related Dacryoadenitis Successfully Treated with Baricitinib. Intern Med 2024; 63:461-464. [PMID: 38296523 PMCID: PMC10901715 DOI: 10.2169/internalmedicine.1862-23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024] Open
Abstract
A 48-year-old woman visited our hospital because of bilateral lacrimal gland enlargement. Her serum immunoglobulin G4 (IgG4) level was high, and positron emission tomography-computed tomography showed significant positive findings in the bilateral lacrimal gland. A biopsy revealed a considerable increase in IgG4/CD138, leading to a diagnosis of IgG4-related dacryoadenitis. The disease did not respond to steroid therapy, so treatment was started with baricitinib because of exacerbation of the original atopic dermatitis and dacryoadenitis after the second dose of the coronavirus disease 2019 (COVID-19) vaccine. Baricitinib was effective for resolving both dermatitis and dacryoadenitis, and steroids were able to be discontinued. The IgG4 level also improved.
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Affiliation(s)
- Atsuhiko Suenaga
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Department of Nephrology, Saga University Internal Medicine, Japan
| | - Naoki Sawa
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yuki Oba
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Daisuke Ikuma
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Department of Nephrology and Rheumatology, Toranomon Hospital, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Department of Nephrology, Saga University Internal Medicine, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Hiroki Mizuno
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Hideki Tsuji
- Department of Ophthalmology, the Cancer Institute Hospital of JFCR, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Motoaki Miyazono
- Department of Nephrology, Saga University Internal Medicine, Japan
| | | | - Yoshifumi Ubara
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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Boualila L, Bouirig K, Tagmouti A, Boutimzine N, Cherkaoui LO, Bouanane R, Touarsa F, Jiddane M, Alloul N, El Ouanass M. Acute suppurative bacterial dacryoadenitis (ASBD) in a child: A rare pseudomonal etiology. J Fr Ophtalmol 2023; 46:e381-e383. [PMID: 37620191 DOI: 10.1016/j.jfo.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 08/26/2023]
Affiliation(s)
- L Boualila
- Département d'ophtalmologie, Hôpital des spécialités, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc..
| | - K Bouirig
- Département d'ophtalmologie, Hôpital des spécialités, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
| | - A Tagmouti
- Département d'ophtalmologie, Hôpital des spécialités, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
| | - N Boutimzine
- Département d'ophtalmologie, Hôpital des spécialités, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
| | - L O Cherkaoui
- Département d'ophtalmologie, Hôpital des spécialités, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
| | - R Bouanane
- Département de radiologie, Hôpital des spécialitiés, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
| | - F Touarsa
- Département de radiologie, Hôpital des spécialitiés, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
| | - M Jiddane
- Département de radiologie, Hôpital des spécialitiés, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
| | - N Alloul
- Laboratoire de bactériologie, Hôpital militaire d'instruction Mohammed V, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
| | - M El Ouanass
- Laboratoire de bactériologie, Hôpital militaire d'instruction Mohammed V, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
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Awada B. Chronic bilateral dacryoadenitis caused by SARS-CoV-2 infection: a case report. J Med Case Rep 2023; 17:441. [PMID: 37872576 PMCID: PMC10594824 DOI: 10.1186/s13256-023-04175-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/11/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Dacryoadenitis is inflammation of the lacrimal gland, mainly caused by viral infection. It can also be caused by bacterial pathogens and non-infectious processes such as auto-immune diseases and malignancy. Chronic dacryoadenitis is rarely linked to SARS-CoV-2 infection, with only five reports in the literature. REPORT A 26-year-old Arab woman experienced chronic inflammatory dacryoadenitis after a mild SARS-CoV-2 infection, which was successfully treated with oral prednisone. CONCLUSIONS Dacryoadenitis can occur due to inflammation caused by either SARS-CoV-2 exposure. The treatment typically involves the administration of steroids, with duration to be decided based on clinical response.
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Affiliation(s)
- Bassem Awada
- Division of Infectious Diseases, Department of Internal Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Al Khoud, PO Box 566, Muscat, Sultanate of Oman.
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Ozkan Arat Y, Bezci Aygün F, Özoğul E, Kalyoncu U. New Onset Isolated Granulomatous Dacryoadenitis During Etanercept Therapy. Ocul Immunol Inflamm 2023; 31:1727-1729. [PMID: 35797360 DOI: 10.1080/09273948.2022.2089687] [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] [Received: 05/15/2022] [Accepted: 06/07/2022] [Indexed: 10/17/2022]
Abstract
Anti-tumor necrosis factor alpha (TNF- α) biological agents can rarely cause sarcoid-like granulomatosis. A 20-year-old woman presented with a 1-month history of painful left upper eyelid swelling. She was on subcutaneous etanercept and methotrexate for 1 year for juvenile idiopathic arthritis. Imaging showed diffuse enlargement of the left and minimal enlargement of the right lacrimal gland. There was no finding in favor of sarcoidosis on systemic evaluation. Incisional biopsy of the left lacrimal gland revealed non-caseating granulomatous dacryoadenitis. The findings showed significant regression 1 month after cessation of Etanercept therapy. To the best of our knowledge, this report illustrates the first case of an isolated granulomatous dacryoadenitis during TNF-α antagonist therapy.
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Affiliation(s)
- Yonca Ozkan Arat
- Department of Ophthalmology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Figen Bezci Aygün
- Department of Ophthalmology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ece Özoğul
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Umut Kalyoncu
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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8
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Zhao X, Li N, Yang N, Mi B, Dang W, Sun D, Ma S, Nian H, Wei R. Thymosin β4 Alleviates Autoimmune Dacryoadenitis via Suppressing Th17 Cell Response. Invest Ophthalmol Vis Sci 2023; 64:3. [PMID: 37531112 PMCID: PMC10405860 DOI: 10.1167/iovs.64.11.3] [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] [Received: 02/13/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose We investigated the therapeutic effect of recombinant thymosin β4 (rTβ4) on rabbit autoimmune dacryoadenitis, an animal model of SS dry eye, and explore its mechanisms. Methods Rabbits were treated topically with rTβ4 or PBS solution after disease onset for 28 days, and clinical scores were determined by assessing tear secretion, break-up time, fluorescein, hematoxylin and eosin staining, and periodic acid-Schiff. The expression of inflammatory mediators in the lacrimal glands were measured by real-time PCR. The expression of T helper 17 (Th17) cell-related transcription factors and cytokines were detected by real-time PCR and Western blotting. The molecular mechanism underlying the effects of rTβ4 on Th17 cell responses was investigated by Western blotting. Results Topical administration of rTβ4 after disease onset efficiently ameliorated the ocular surface inflammation and relieved the clinical symptoms. Further analysis revealed that rTβ4 treatment significantly inhibited the expression of Th17-related genes (RORC, IL-17A, IL-17F, IL-1R1, IL-23R, and granulocyte-macrophage colony-stimulating factor) and IL-17 protein in lacrimal glands, and meanwhile decreased the inflammatory mediators expression. Mechanistically, we demonstrated that rTβ4 repressed the phosphorylation of signal transducer and activator of transcription 3 (STAT3) both in vivo and in vitro. Activation of the STAT3 signal pathway by Colivelin partly reversed the suppressive effects of rTβ4 on IL-17 expression in vitro. Conclusions rTβ4 could alleviate ongoing autoimmune dacryoadenitis in rabbits, probably by suppressing Th17 response via partly affecting the STAT3 pathway. These data may provide a new insight into the therapeutic effect and mechanism of rTβ4 in dry eye associated with Sjögren's syndrome.
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Affiliation(s)
- Xiaoyu Zhao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Na Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Ning Yang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Baoyue Mi
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Weiyu Dang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Deming Sun
- Doheny Eye Institute and Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California, United States
| | - Shanshan Ma
- Beijing Northland Biotech. Co., Ltd., Beijing, China
| | - Hong Nian
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Ruihua Wei
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Jossy A, Kaviyapriya N, Kasturi N, Rekha JS. Isolated tubercular dacryoadenitis in a non-immunocompromised healthy adult. INDIAN J PATHOL MICR 2023; 66:608-610. [PMID: 37530351 DOI: 10.4103/ijpm.ijpm_489_21] [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: 08/03/2023] Open
Abstract
A middle-aged woman presented with a slowly enlarging mass in the right superotemporal orbit and ptosis. The patient had an elevated erythrocyte sedimentation rate, and incisional biopsy showed granulomatous inflammation with Langhan's giant cells suggestive of a tubercular etiology. Tuberculin skin test was negative. The patient responded well to anti-tuberculous therapy. Tubercular dacryoadenitis is a rare presentation of a lacrimal gland mass.
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Affiliation(s)
- Ajax Jossy
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
| | - N Kaviyapriya
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
| | - Nirupama Kasturi
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
| | - J Sree Rekha
- Department of Pathology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
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Silva Neto F, Gadelha C, Silva L, Pazos N, Silva A, Silva M, Sousa B, Bernardes Dulgheroff AC, Guerra F, Magalhães da Silveira V, Oliveira M, Lima Neto R. Case Report: Ocular Sporotrichosis-A Seven-Case Series. Am J Trop Med Hyg 2023; 108:1109-1114. [PMID: 37188341 PMCID: PMC10540119 DOI: 10.4269/ajtmh.22-0501] [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] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/19/2022] [Indexed: 05/17/2023] Open
Abstract
Ocular infections associated with sporotrichosis can present four clinical manifestations: granulomatous conjunctivitis, dacryocystitis, Parinaud oculoglandular syndrome, and bulbar conjunctivitis. The incidence of ocular sporotrichosis related to zoonotic transmission has significantly increased in endemic regions and is a frequently misdiagnosed cause of granulomatous conjuntivitis. Therefore, we present a series of seven cases of eye injury by Sporothrix strains, including clinical forms, therapeutic approaches, and laboratory procedures to alert health professionals who provide care to these patients.
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Affiliation(s)
- Francisco Silva Neto
- Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Brazil
- Department of Infectious, Parasitic and Inflammatory Diseases, Center for Medical Sciences, Federal University of Paraíba, João Pessoa, Brazil
| | - Camila Gadelha
- Undergraduated Course in Medicine, Center for Medical Sciences, Federal University of Paraíba, João Pessoa, Brazil
| | - Larissa Silva
- Post-Graduate Program in Bioactive Synthetic Natural products, Federal University of Paraíba, João Pessoa, Brazil
| | - Natália Pazos
- Post-Graduate Program in Bioactive Synthetic Natural products, Federal University of Paraíba, João Pessoa, Brazil
| | - Alan Silva
- Technical Health School, Federal University of Paraíba, João Pessoa, Brazil
| | - Mayara Silva
- Post-Graduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Brazil
| | - Bruna Sousa
- Post-Graduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Brazil
| | | | - Felipe Guerra
- Post-Graduate Program in Bioactive Synthetic Natural products, Federal University of Paraíba, João Pessoa, Brazil
| | - Vera Magalhães da Silveira
- Department of Tropical Medicine, Center for Medical Sciences, Federal University of Pernambuco, Recife, Brazil
| | - Manoel Oliveira
- Instituto Oswaldo Cruz (IOC/FIOCRUZ), Rio de Janeiro, Brazil
| | - Reginaldo Lima Neto
- Post-Graduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Brazil
- Department of Tropical Medicine, Center for Medical Sciences, Federal University of Pernambuco, Recife, Brazil
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11
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Ito M, Vaidya A, Kakizaki H, Takahashi Y. Spontaneous regression of immunoglobulin G4-related dacryoadenitis and multiple organ involvement: A case report. Medicine (Baltimore) 2023; 102:e32618. [PMID: 36607859 PMCID: PMC9829289 DOI: 10.1097/md.0000000000032618] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Immunoglobulin G4 (IgG4)-related dacryoadenitis is rarely resolved spontaneously without steroids. Here, we report a case of IgG4-related dacryoadenitis and extra-ophthalmic lesions with spontaneous regression. METHODS This is a clinical case report. A 56-years-old man had a 1-year and 7-month-old histories of neck and eyelid swelling, respectively. On the first examination, the lacrimal and submandibular glands were palpable bilaterally. Computed tomographic images showed enlargement of the lacrimal gland on both sides, right pulmonary hilar lymph node, and pancreas, and thickening of the abdominal aortic wall. Blood tests demonstrated elevated serum IgG4 level and positive hepatitis B surface antibody. Pathological examination of the biopsied lacrimal gland specimens revealed marked IgG4-positive plasma cell infiltration. RESULTS The patient was monitored carefully without steroid administration. Serum IgG4 level had gradually decreased during follow-up period and reached the normal range 3 years after the biopsy. At 4-year follow-up, the lacrimal and submandibular glands were not palpable on either side. Computed tomographic images demonstrated no enlargement of the lacrimal gland, submandibular gland, or lymph nodes, and improvement of the enlarged pancreas and thickened abdominal aortic wall. CONCLUSION Our case indicates that careful observation can be an option in selected cases with risks of steroid treatment or silent clinical course.
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Affiliation(s)
- Mayari Ito
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Aric Vaidya
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Kirtipur Eye Hospital, Kathmandu, Nepal
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
- * Correspondence: Yasuhiro Takahashi, Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195, Japan (e-mail: )
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Yue J, Wang CM, Lyu JX, Jian SJ, Niu YY, Liu SS, Sun ST, Han L, Zhang HM. [Susceptibility of drug-resistant staphylococci isolated from different parts of the ocular anterior segment to common ophthalmic antibiotics]. Zhonghua Yan Ke Za Zhi 2022; 58:598-605. [PMID: 35959604 DOI: 10.3760/cma.j.cn112142-20220119-00023] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objectie To investigate the susceptibility of drug-resistant staphylococci isolated from different parts of the anterior segment to levofloxacin, tobramycin, cefazolin sodium, fusidic acid and clindamycin. Methods: Experimental Study. A total of 67 patients with anterior segment infection (33 cases of conjunctivitis, 6 cases of bacterial keratitis, 7 cases of blepharitis, 9 cases of neonatal dacryocystitis, 9 cases of neonatal dacryocystitis, 1 case of adult dacryocystitis and 11 cases of other infectious eye diseases) were collected from the conjunctival sac, cornea, eyelid margin and lacrimal sac. Minimum inhibitory concentration (MIC) determination of methicillin-resistant Staphylococcus (MRS) strains and β-lactamase-producing (β-Lac) strains by a micro-liquid-based method, according to the M100 standard of the American Institute for Clinical and Laboratory Standardization Susceptibility and resistance determinations were made. Data were statistically analyzed using Chi-square or Fisher's exact test. Results: Thirty-five MRS, 30 β-Lac and 2 β-Lac MRS isolates were identified from 67 multidrug-resistant Staphylococcus . There were 3, 9, 4, and 19 MRS isolates isolated from the lacrimal sac, cornea, eyelid margin and conjunctival sac, accounting for 3/4, 9/12, 4/8, 19/43 (44.2%) of the isolated sites respectively. There were 1, 3, 3, and 23 β-Lac isolates, accounting for 1/4, 3/12, 3/8 and 23/43 (53.5%) of the isolated sites, respectively. The highest proportion of β-Lac isolates isolated from patients with a diagnosis of conjunctivitis was 17 (25.3%) from the conjunctival sac. Among the MRS strains isolated from the cornea and lacrimal sac, 5 (7.5%) and 3 (4.5%) were from patients diagnosed with bacterial keratitis and neonatal tear, respectively. The number of MRS strains and β-Lac isolates isolated from patients with a diagnosis of blepharitis were both 3 (4.5%) from the lid margin.Among the strains isolated from the eyelid margin and the conjunctival sac, drug-resistant Staphylococcus epidermidis was the main strain, the drug-resistant Staphylococcus aureus was the major isolates in lacrimal sac and cornea. Among the 35 MRS isoaltes, 25, 24, 12, 12, and 11 were sensitive to cefazolin sodium, fusidic acid, levofloxacin, clindamycin and tobramycin, and the sensitivity rates were 71.4%, 68.6%, 34.3%, 34.3% and 31.4%, the difference was statistically significant (χ2=22.756, P<0.001), The sensitivity rates of levofloxacin, tobramycin, cefazolin sodium, fusidic acid and clindamycin against MRS isolates from the anterior segment were both statistically significant differences (χ2=18.493, 11.594, 8.906, 9.841, 16.059; all P<0.05). The susceptibility rates of MRS isolates against five antibiotics was statistically significant differences (χ2=33.080, P<0.001). Among the 30 β-Lac isolates, 27, 22, 19, 16, and 8 were sensitive to cefazolin sodium, fusidic acid, levofloxacin, tobramycin and clindamycin, and the sensitivity rates were 90.0 % , 73.3%, 63.3%, 53.3% and 26.7%, the difference was statistically significant (χ2=28.280, P<0.001). The sensitivity rates of five antibiotics against β-Lac isolates from the anterior segment were both statistically significant differences (χ2=50.971, 24.543, 48.147, 44.899, 18.676; all P<0.001). The susceptibility rates of β-Lac isolates against five antibiotics was statistically significant differences (χ2=23.383, P<0.001). The sensitivity of cefazolin sodium and fusidic acid against β-Lac isolates were higher than MRS isolates. Conclusions: Cefazolin sodium and fusidic acid may be the best choice for the treatment of drug-resistant Staphylococcus isolated from anterior conjunctival sac, cornea, eyelid margin and lacrimal sac, especially for β-Lac-producing drug-resistant Staphylococcus infection.
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Affiliation(s)
- J Yue
- Department of Ophthalmology, Henan Provincial People's Hospital of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, School of Clinical Medicine, Ophthalmology Department of Henan University, People's Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Ophthalmology and Visual Science, Zhengzhou 450003, China
| | - C M Wang
- Department of Ophthalmology, Henan Provincial People's Hospital of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, School of Clinical Medicine, Ophthalmology Department of Henan University, People's Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Ophthalmology and Visual Science, Zhengzhou 450003, China
| | - J X Lyu
- Department of Ophthalmology, Henan Provincial People's Hospital of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, School of Clinical Medicine, Ophthalmology Department of Henan University, People's Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Ophthalmology and Visual Science, Zhengzhou 450003, China
| | - S J Jian
- Department of Ophthalmology, Henan Provincial People's Hospital of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, School of Clinical Medicine, Ophthalmology Department of Henan University, People's Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Ophthalmology and Visual Science, Zhengzhou 450003, China
| | - Y Y Niu
- Department of Ophthalmology, Henan Provincial People's Hospital of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, School of Clinical Medicine, Ophthalmology Department of Henan University, People's Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Ophthalmology and Visual Science, Zhengzhou 450003, China
| | - S S Liu
- Department of Ophthalmology, Henan Provincial People's Hospital of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, School of Clinical Medicine, Ophthalmology Department of Henan University, People's Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Ophthalmology and Visual Science, Zhengzhou 450003, China
| | - S T Sun
- Department of Ophthalmology, Henan Provincial People's Hospital of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, School of Clinical Medicine, Ophthalmology Department of Henan University, People's Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Ophthalmology and Visual Science, Zhengzhou 450003, China
| | - L Han
- Department of Ophthalmology, Henan Provincial People's Hospital of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, School of Clinical Medicine, Ophthalmology Department of Henan University, People's Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Ophthalmology and Visual Science, Zhengzhou 450003, China
| | - H M Zhang
- Department of Ophthalmology, Henan Provincial People's Hospital of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, School of Clinical Medicine, Ophthalmology Department of Henan University, People's Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Ophthalmology and Visual Science, Zhengzhou 450003, China
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Martínez Díaz M, Copete Piqueras S, Blanco Marchite C, Vahdani K. Acute dacryoadenitis in a patient with SARS-CoV-2 infection. Orbit 2022; 41:374-377. [PMID: 33402004 DOI: 10.1080/01676830.2020.1867193] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [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] [Received: 09/28/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
We describe a retrospective case report of dacryoadenitis associated with orbital inflammatory disease in a patient with confirmed SARS-CoV-2 infection.A 22-year-old previously fit and healthy male presented with 4-day history of right ocular redness, eyelid swelling and blurred vision associated with discomfort and pain in the lacrimal gland area. He was found to have right acute dacryoadenitis based on clinical examination and orbital imaging. One day after initiation of oral antibiotic and non-steroidal anti-inflammatory therapy, he developed worsening of the orbital inflammation and partial ophthalmoplegia. Oral steroids were commenced resulting in rapid resolution of symptoms within a few days and clinical stability at 2 months.The patient did not have any systemic features of COVID-19 but he was in close contact with his mother and with his partner who both had respiratory symptoms and tested positive for SARS-CoV-2 antigen (PCR testing) 4 weeks prior. PCR testing from nasopharyngeal swab was negative for SARS-CoV-2 RNA; however, the serological test was positive for IgM/IgG SARS-CoV-2 antibodies. Extensive laboratory workup including infectious and autoimmune screening and chest x-ray were unremarkable.Orbital inflammatory disease due to infectious process or immunological response may potentially occur in COVID-19 patients, although the causal relationship remains uncertain.
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Affiliation(s)
| | | | | | - Kaveh Vahdani
- Adnexal Service, Moorfields Eye Hospital, NHS Trust, London, UK
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Watanabe T, Yamashita T, Sugawara H. Epstein-Barr Virus Dacryoadenitis in a Young Woman. Intern Med 2022; 61:1629. [PMID: 35569929 PMCID: PMC9177378 DOI: 10.2169/internalmedicine.8004-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tamami Watanabe
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Takeshi Yamashita
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Hitoshi Sugawara
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
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Yoshida Y, Kondo T, Hosokawa Y, Oki K, Yukawa K, Araki K, Kohno H, Kuranobu T, Tokunaga T, Oi K, Sugimoto T, Oda K, Nojima T, Hirata S, Sugiyama E. A Rare Case of IgG4-Related Disease Presenting as a Unilateral Severe Dacryoadenitis Complicated by Hypophysitis and Hypertrophic Pachymeningitis. J Clin Rheumatol 2021; 27:S571-S573. [PMID: 30724757 DOI: 10.1097/rhu.0000000000000989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alam MS, Poonam NS, Koka K, Vijay V, Ganesh S. Intracanalicular antibiotic ointment loading as a management option for canaliculitis. Orbit 2021; 40:295-300. [PMID: 32787481 DOI: 10.1080/01676830.2020.1801763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 06/01/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
AIM The aim of the study is to describe intracanalicular antibiotic ointment loading as a treatment option for canaliculitis. MATERIAL AND METHODS It was an interventional prospective study. The study was conducted over a 3 year period from June 2015 to June 2018. All patients of canaliculitis managed with intracanalicular antibiotic ointment loading and with a minimum follow up of 3 months were included in the study. The antibiotic ointment was loaded into the canaliculus based on the antibiotic sensitivity of the material expressed out from the canaliculus. Patients' demographics, clinical details, microbiological profile and management outcomes were evaluated. RESULTS A total of 24 patients were included in the study. Mean age at presentation was 58.41 ± 9.4 years. The right eye was involved in 15 (62.5%, p = .0424) cases. The incidence of lower canaliculus involvement (14, 58.33%, p = .022) was significantly higher as compared to the upper canaliculus (8, 33.33%). Staphylococcus epidermidis and Actinomyces israelii (6, 25%) were the most commonly isolated organisms. Mean number of intracanalicular antibiotic loading sessions required was 4.21 ± 1.69 (range 2-8). Complete resolution of canaliculitis was seen in all (100%) cases. CONCLUSION Canalicular antibiotic ointment loading is a minimally invasive, safe, and effective procedure. It preserves the anatomy and function of the punctum and canaliculus and can be considered as one of the management options for canaliculitis.
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Affiliation(s)
- Md Shahid Alam
- Orbit, Oculoplasty, Reconstructive & Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, (A Unit of Medical Research Foundation, Chennai), India
| | - Nisar Sonam Poonam
- Orbit, Oculoplasty, Reconstructive & Aesthetic Services, Sankara Nethralaya, Chennai, India
| | - Kirthi Koka
- Orbit, Oculoplasty, Reconstructive & Aesthetic Services, Sankara Nethralaya, Chennai, India
| | - Vathsalya Vijay
- Orbit, Oculoplasty, Reconstructive & Aesthetic Services, Sankara Nethralaya, Chennai, India
| | - Sri Ganesh
- Nethradhama Superspecialty Eye Hospital, Bangalore, India
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Marqués Fernández VE, Galindo Ferreiro A. Acute dacryocystitis retention syndrome due to Epstein-Barr virus. Arch Soc Esp Oftalmol (Engl Ed) 2021; 96:321-325. [PMID: 34092286 DOI: 10.1016/j.oftale.2020.07.016] [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] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/20/2020] [Indexed: 06/12/2023]
Abstract
A 4 year-old boy with no previous history of eye or nasolacrimal disease was referred due to a painful mass on his left inner canthus, of three days onset, with no improvement in spite of oral antibiotics. On examination eyelid oedema with periocular hyperaemia was noted. Lacrimal sac palpation was painful and tonsillar exudation was reported. He was admitted and started on intravenous (iv) antibiotics. Four days later, lacrimal signs started to improve, but his general condition become worse. Head and neck Computed Tomography scan (CT scan) showed a left lacrimal sac enlargement, suggestive of acute dacryocystitis and swollen laterocervical lymph nodes. Epstein Barr Virus (EBV) serology and PCR testing were positive. The child responded well after eight days, and was discharged with oral antibiotics. Acute dacryocystic retention (ADR) associated with EBV was suspected. Six months later, the patient remained asymptomatic with no tearing or other lacrimal symptoms.
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Affiliation(s)
- V E Marqués Fernández
- Departamento de Oftalmología, Hospital Universitario Río Hortega, Valladolid, Spain.
| | - A Galindo Ferreiro
- Departamento de Oftalmología, Hospital Universitario Río Hortega, Valladolid, Spain
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Qing H, Yang Z, Shi M, Zhang J, Sun S, Han L. Microbial spectrum and antibiotic sensitivity in infantile dacryocystitis. Graefes Arch Clin Exp Ophthalmol 2021; 259:1263-1272. [PMID: 33417095 DOI: 10.1007/s00417-020-05026-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 11/03/2020] [Accepted: 11/23/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To identify the characteristics and the spectrum of microbial agents of infantile dacryocystitis and to assess the trends in both antibiotic sensitivities and pathogens over the past 10 years. METHODS The microbial and medical records of 546 culture-proven patients (546 eyes) of infantile dacryocystitis diagnosed at Henan Eye Hospital between January 2009 and December 2018 were retrospectively reviewed. Patient demographics, microbial analysis, and susceptibility rates to various antibiotics were done. A chi-squared test for trends was applied to evaluate changes in antibiotic susceptibility and microbial spectrum over time. RESULTS A total of 546 patients with infantile dacryocystitis were documented. The average age was 2.97 ± 4.15 months, and 42.7% were female. The proportion of gram-positive microbes, gram-negative microbes, and fungi was 80.2, 19.4, and 0.4%, respectively. Minocycline was sensitive to gram-positive bacteria (98.0%). Imipenem was sensitive to gram-negative bacteria (89.2%). Increasing susceptibility was observed in two bacterial isolates: Staphylococcus aureus (P = 0.005) and Streptococcus mitis (P = 0.001). Decreasing susceptibility was observed in one bacterial isolate: Staphylococcus epidermidis (P < 0.0001). Increasing microbial susceptibility over time was detected for 12 antibiotics. Decreasing microbial sensitivity was observed for one antibiotic. CONCLUSIONS The most common cause of infantile dacryocystitis is Staphylococcus epidermidis. Though a significant trend towards increasing microbial sensitivity to some antibiotics was observed, including glycopeptides, cephalosporins, fluoroquinolones, tetracyclines, and lincosamides, a significant trend towards decreasing microbial sensitivity to amikacin was also detected.
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Affiliation(s)
- Huiling Qing
- Department of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, NO.7, Wei-wu Road, Zhengzhou, 450003, China.
| | - Zhengwei Yang
- Department of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, NO.7, Wei-wu Road, Zhengzhou, 450003, China
| | - Menghai Shi
- Department of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, NO.7, Wei-wu Road, Zhengzhou, 450003, China
| | - Junge Zhang
- Department of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, NO.7, Wei-wu Road, Zhengzhou, 450003, China
| | - Shengtao Sun
- Department of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, NO.7, Wei-wu Road, Zhengzhou, 450003, China
| | - Lei Han
- Department of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, NO.7, Wei-wu Road, Zhengzhou, 450003, China
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Abstract
RATIONALE Sporotrichosis is the most common subcutaneous mycosis. It is caused by the dimorphic fungus Sporothrix schenckii. Ocular sporotrichosis is uncommon and has been rarely reported. PATIENT CONCERNS We describe a 34-year-old female who presented with a nodule increasing in size near the medial angle of the left eye. Originally, she was misdiagnosed with a dacryocyst space-occupying lesion, and the lesion was removed by surgery. DIAGNOSES Findings of fungal structures in the histopathological examination contributed to the diagnosis of Sporothrix dacryocystitis. Further culture of conjunctival secretions and contact lens storage solution was positive for Sporothrix. INTERVENTIONS She was treated with oral itraconazole, 200 mg by mouth twice daily. OUTCOMES After 3 months of treatment with oral itraconazole, culture of the conjunctival secretions was negative. LESSONS It is of paramount importance to clinically suspect mycosis, even in unusual locations or in the absence of the typical epidemiological history.
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Affiliation(s)
- Lixia Sun
- Department of Ophthalmology, Yanbian University Affiliated Hospital, Yanbian University, Yanji
| | - Yaru Dong
- Department of Ophthalmology, Second Hospital of Jilin University, Jilin University, Changchun
| | - Xin Wang
- Department of Ophthalmology, Jiin Guowen Hospital, Gongzhuling
| | | | - Min Zhang
- Department of Pathology, Second Hospital of Jilin University, Jilin University, Changchun, Jilin, P.R. China
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Abstract
Acute dacryoadenitis with abscess formation has been rarely described. We describe four cases that resolved with incision and drainage. This includes a retrospective case series of four patients with radiologically confirmed lacrimal gland abscesses and a review of the reported cases in the literature. Computed tomography showed characteristic rim enhancing collections with central attenuation in all four cases. All patients presented with ptosis, upper eyelid erythema, and severe pain similar to scleritis. Injection of the conjunctiva and sclera was present in two patients, and a third patient presented with expression of purulent discharge onto the ocular surface upon palpation of the lacrimal gland. All patients were treated with intravenous antibiotics and underwent incision and drainage with subsequent improvement. All were monitored for 24 to 48 hours and discharged on oral antibiotics. There were no complications or recurrences. Lacrimal gland abscess formation is a rare complication of dacryoadenitis, and in our experience these patients respond well to incision and drainage in combination with systemic antibiotics.
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Affiliation(s)
- Brian Savoie
- a Department of Ophthalmology , Hofstra Northwell School of Medicine , Great Neck , New York , USA
| | - Rand Rodgers
- b Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Matthew Gorski
- a Department of Ophthalmology , Hofstra Northwell School of Medicine , Great Neck , New York , USA
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Sengor T, Yuzbasioglu E, Aydın Kurna S, Irkec M, Altun A, Kökcen K, Yalcin NG. Dacryoadenitis and extraocular muscle inflammation associated with contact lens-related Acanthamoeba keratitis: A case report and review of the literature. Orbit 2017; 36:43-47. [PMID: 27874294 DOI: 10.1080/01676830.2016.1243132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 06/06/2023]
Abstract
The present report discusses a new case of dacryoadenitis with extraocular muscle inflammation associated with Acanthamoeba keratitis (AK) in a contact lens wearer. A 41-year-old male, who has worn silicone hydrogel contact lenses on an extended basis for about 10 years, attended with the complaints of vision disturbance, hyperemia, and pain in his right eye. His history revealed that 1.5 month ago, he had been diagnosed with allergic conjunctivitis and had used steroid eye drops. Biomicroscopic examination revealed eyelid edema, chemosis, and ring infiltration, radial keratoneuritis and an epithelial defect in the cornea. Magnetic resonance imaging demonstrated enlarged lacrimal gland with edematous changes consistent with inflammation due to dacryoadenitis. There were also thickening and edema of the right superior oblique and lateral rectus muscle. The treatment protocol for AK was applied with no specific treatment for dacryoadenitis. After 4 months of the treatment, dacryoadenitis and keratitis regressed. Dacryoadenitis and extraocular muscle inflammation may accompany AK more frequently than expected and previously known. The evaluation of the lacrimal gland and extraocular muscles in presence of AK might be beneficial for understanding better the exact clinical picture and course of the keratitis.
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Affiliation(s)
- Tomris Sengor
- a Department of Ophthalmology , Bilim University, Florence Nightingale Hospital , Istanbul , Turkey
| | - Erdal Yuzbasioglu
- a Department of Ophthalmology , Bilim University, Florence Nightingale Hospital , Istanbul , Turkey
| | - Sevda Aydın Kurna
- b Clinic of Ophthalmology , Fatih Sultan Mehmet Education and Research Hospital , Istanbul , Turkey
| | - Murat Irkec
- c Department of Ophthalmology , Hacettepe University , Ankara , Turkey
| | - Ahmet Altun
- b Clinic of Ophthalmology , Fatih Sultan Mehmet Education and Research Hospital , Istanbul , Turkey
| | - Kubra Kökcen
- b Clinic of Ophthalmology , Fatih Sultan Mehmet Education and Research Hospital , Istanbul , Turkey
| | - Nazli Gul Yalcin
- a Department of Ophthalmology , Bilim University, Florence Nightingale Hospital , Istanbul , Turkey
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Jakobiec FA, Syed ZA, Stagner AM, Harris GJ, Rootman J, Yoon MK, Mombaerts I. Orbital Inflammation in Pregnant Women. Am J Ophthalmol 2016; 166:91-102. [PMID: 27038895 DOI: 10.1016/j.ajo.2016.03.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 02/04/2016] [Revised: 03/18/2016] [Accepted: 03/23/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To analyze overlaps between pregnancy and orbital inflammation (OI). DESIGN Retrospective observational case series. METHODS Eight new cases from 1997 to 2015 and 2 previously published cases were identified for inclusion in this investigation to provide the fullest clinical picture. Medical records, imaging studies, and the results of biopsies were reviewed. RESULTS Three categories of association were discovered: (1) OI arising for the first time during pregnancy (5 cases); (2) OI arising within 3 months of delivery (2 cases); and (3) previously diagnosed OI reactivated or exacerbated by pregnancy (3 cases). One patient had a preexistent systemic autoimmune disease and another's was later diagnosed. One patient had attacks during sequential pregnancies. Findings included eyelid swelling and erythema, conjunctival chemosis, pain on eye movement, minimal diplopia, the usual absence of proptosis, and general preservation of visual acuity. Imaging studies disclosed extraocular muscle swelling (8 cases), most frequently of a single lateral rectus muscle. There were 2 cases of dacryoadenitis; 1 of these and an additional case displayed inflammation of the retrobulbar fat. Corticosteroids effected resolution of most symptoms. Singleton births were normal with the exceptions of an intrauterine fetal demise owing to acrania and a molar pregnancy. CONCLUSION OI usually affects a single rectus muscle (typically the lateral) and, less often, the lacrimal gland and is often mild when it arises during or after pregnancy. Independent systemic autoimmune disease is an uncommon feature. Corticosteroids were efficacious except in 1 case with severe orbital scarring. No definitive causal relationships between pregnancy and OI could be established based on the clinical data.
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Affiliation(s)
- Frederick A Jakobiec
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
| | - Zeba A Syed
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Anna M Stagner
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Gerald J Harris
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jack Rootman
- Department of Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Michael K Yoon
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
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Ramírez Soto MC. Sporotrichosis in the Ocular Adnexa: 21 Cases in an Endemic Area in Peru and Review of the Literature. Am J Ophthalmol 2016; 162:173-179.e3. [PMID: 26585212 DOI: 10.1016/j.ajo.2015.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 05/03/2015] [Revised: 11/08/2015] [Accepted: 11/09/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the clinical and epidemiologic characteristics of sporotrichosis in ocular adnexa and give an insight into factors associated with this condition. DESIGN Retrospective case series and literature review. METHODS We retrospectively reviewed all cases of sporotrichosis in ocular adnexa between 2004 and 2014 in the Santa Teresa Clinic of Abancay, Peru and reviewed all case reports of sporotrichosis in ocular adnexa in the literature. RESULTS We reviewed records of 21 patients with sporotrichosis in ocular adnexa; 12 (57.1%) of them were male and their median age surrounded 9 years. In our series, 19 patients had lesions in the eyelids and 2 in the eyebrows. The lymphocutaneous form occurred in 62% of them. Ten patients (47.6%) were cured with potassium iodide. Among 65 patients with sporotrichosis in ocular adnexa (our 21 patients and 44 from the literature), the average age was 9 years, and 78% were ≤15 years of age; 54% were male. The lesions were more frequent on the eyelids (n = 53 [82%]), followed by the lacrimal gland (n = 5), conjunctiva (n = 4), and eyebrows (n = 3). The lymphocutaneous clinical form (54%) was the most frequent. Fifty patients were cured: 31 of them with potassium iodide, 16 with itraconazole, and 3 with a combination including potassium iodide, itraconazole, and fluconazole. Twenty-nine patients (44.6%) resided in a hyperendemic region, and 5 patients reported contact with cats that had sporotrichosis. CONCLUSIONS Sporotrichosis in ocular adnexa is associated with children ≤15 years of age, and in 82% of these cases the disease is limited to the eyelids.
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Affiliation(s)
- Max Carlos Ramírez Soto
- Unidad de Postgrado, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru.
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Uth CC, Voorde PT, Boljanovic S. [Dacryocystitis in a three-week-old girl]. Ugeskr Laeger 2015; 177:V04150369. [PMID: 26509540] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Dacryocystocele is a rare disease, which can be difficult to distinguish from haemangioma, dermoid cyst or encephalocele. Proper diagnosis and treatment is important as the risk of complications is high. A newborn baby with dacryocystitis was referred to a department of plastic surgery with a bluish tumour in the medial corner of the eye. The girl was treated with i.v. antibiotics and the dacryocystocele disappeared in 20 days. Knowledge of the disease is important so patients quickly can be treated medically and possibly surgically in order to avoid fatal complications.
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Coloma-González I, Ceriotto A, Flores-Preciado J, Corredor-Casas S, Salcedo-Casillas G. [Comparative study of clinical features between unilateral and bilateral orbital IgG4-related disease]. Arch Soc Esp Oftalmol 2015; 90:407-413. [PMID: 25865652 DOI: 10.1016/j.oftal.2015.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 02/09/2015] [Accepted: 02/24/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Descriptive and comparative study of patients with orbital IgG4-related disease. MATERIAL AND METHODS A review and analysis of the cases diagnosed with inflammatory orbital lesion related to IgG4 by the Ophthalmic Pathology Service in the Dr. Luis Sánchez Bulnes Hospital. RESULTS A total of 9 cases were found, in which 66% were women, and with a mean age of 48 years and time to diagnosis of 2 years. Unilateral involvement was observed in 56% of cases. All the females experienced pain, and there was an optimal response to corticosteroid treatment in 100% of patients who required medical treatment (one case showed spontaneous resolution). In bilateral cases (44%), only 25% were female, and none had pain as a presenting symptom. Furthermore, 25% of these patients required a combination with immunosuppressants to control inflammation. CONCLUSIONS Clinical presentation of patients with unilateral orbital IgG4-related disease differs from those with bilateral involvement.
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Affiliation(s)
- I Coloma-González
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México.
| | - A Ceriotto
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México
| | - J Flores-Preciado
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México
| | - S Corredor-Casas
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México
| | - G Salcedo-Casillas
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México
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Takahashi H, Suzuki C, Yamamoto M. [112th Scientific Meeting of the Japanese Society of Internal Medicine: Symposium: Recent Progress in IgG4-related Disease: IgG4-related Dacryoadenitis and Sialadenitis]. Nihon Naika Gakkai Zasshi 2015; 104:1838-1843. [PMID: 30160920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Griffiths U, Kumar D, Trimble M, Prabhavalkar S. An unusual Cause of Periorbital Swelling in a Young Female. Acute Med 2015; 14:68-94. [PMID: 26529797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
The aim of this report is to present a case of a patient with bilateral lacrimal gland abscesses in the course of dacryoadenitis. A 45-year-old female patient with a long history of cocaine abuse presented with bilateral bacterial dacryoadenitis and upper lid inflammation with purulent discharge from a palpebral wound of the right upper lid. The diagnosis was confirmed with microbiology culture and an orbital CT scan, which revealed lacrimal gland abscesses. The patient admitted to vigorous eye scratching, which we believe was the mechanism responsible for the process. The infection resolved on targeted antibiotic therapy. This is the first reported case of bilateral infectious dacryoadenitis produced in a self-inflicted mechanism in a cocaine addict.
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Affiliation(s)
- Marta Latasiewicz
- Department of Ophthalmology, Hospital Clinic de Barcelona , Barcelona , Spain
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Jakobiec FA, Rashid A, Lane KA, Kazim M. Granulomatous dacryoadenitis in regional enteritis (crohn disease). Am J Ophthalmol 2014; 158:838-844.e1. [PMID: 25036879 DOI: 10.1016/j.ajo.2014.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 05/17/2014] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the clinical and immunopathologic features of 2 patients with bilateral dacryoadenitis associated with regional enteritis. DESIGN Retrospective, clinicopathologic study. METHODS Clinical records, photographs, and imaging studies were reviewed and microscopic sections of lacrimal gland biopsy samples were critically re-evaluated. The microscopic slides were stained with hematoxylin and eosin, special stains for organisms, and a range of immunohistochemical biomarkers, including CD3, CD4, CD5, CD8, CD20, CD68, CD138, CD1a, and immunoglobulins Ig G, IgG4, and IgA. RESULTS Both patients were young women with a well-established diagnosis of regional enteritis. Histopathologic examination of biopsy samples disclosed moderate intraparenchymal fibrosis and lymphoplasmacytic infiltrates without lymphoid follicles. Small to medium intraparenchymal, noncaseating granulomas lacking multinucleated giant cells and, in 1 patient, CD68-positive and CD1a-negative palisading granulomas in widened interlobular fibrous septa were detected. Vasculitis and IgG4 plasma cells were not observed. Additional immunohistochemical studies revealed that CD8 T lymphocytes (suppressor or cytotoxic subset) predominated over CD4-positive T lymphocytes (helper cells) surrounding the necrobiotic foci and were intermixed with the CD68-positive histiocytes in the absence of CD20 B lymphocytes. Special stains for organisms demonstrated negative results. CONCLUSIONS Dacryoadenitis is the rarest form of ocular adnexal involvement in regional enteritis, which affects the orbit far more frequently than ulcerative colitis. It is a granulomatous process with the possibility of palisading necrobiotic foci. In contrast, ulcerative colitis causes an interstitial lymphocytic and nongranulomatous myositis. Sarcoidosis, Wegener granulomatosis, and pseudorheumatoid nodules must be ruled out. Treatment options entail a wide variety of agents with selection based on empirical considerations and tailored to the patient's symptoms.
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Affiliation(s)
- Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - Alia Rashid
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | | | - Michael Kazim
- Edward S. Harkness Eye Institute of the New York Hospital Presbyterian Medical Center, and Columbia University, New York, New York
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Abstract
A previously healthy 23-month-old girl was admitted for the management of an acute unilateral dacryocystitis following accidental contact with dog faeces. No periocular trauma was reported. Microbiological investigation showed a multiresistant strain of Pantoea species to be the responsible pathogen. The infection responded to a course of oral Clindamycin and Ciprofloxacin, in combination with Chloramphenicol eye drops. This is the first report of an acute dacryocystitis sustained by this microorganism.
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Affiliation(s)
- Bruno Zuberbuhler
- Manchester Academic Health Science Centre,Manchester Royal Eye Hospital, Oxford Road, Manchester, UK.
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Prasannaraj T, Kumar BYP, Narasimhan I, Shivaprakash KV. Significance of adjunctive mitomycin C in endoscopic dacryocystorhinostomy. Am J Otolaryngol 2012; 33:47-50. [PMID: 21392851 DOI: 10.1016/j.amjoto.2011.01.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [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: 08/24/2010] [Revised: 12/16/2010] [Accepted: 01/24/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study is to observe the effect of intraoperative topical application of mitomycin C (MMC) on the results of endoscopic dacryocystorhinostomy. DESIGN This is a prospective, randomized, controlled, single-blind study. SETTINGS Hospitalized treatment was done in a tertiary medical college hospital and research center that deals with a predominantly rural population. PATIENTS Patients with primary acquired postsaccal obstruction causing chronic dacryocystitis were considered. METHODS A total of 38 patients were randomized into either a mitomycin group or a control group. Both of these groups were subjected to an identical surgical procedure, except that 0.2 mg/dL of MMC was used in the mitomycin group, whereas normal saline was used in the control group. The follow-up period was at least 6 months. An asymptomatic patient with a visible stoma at nasendoscopy and free flow of saline into the nose with lacrimal syringing after 6 months after surgery was used as criteria for defining a successful result. RESULTS The success rate was 82.3% when MMC was used and 85.7% among the controls (P > .05). Granulations, adhesions, and obliterative sclerosis occurred in a similar number of patients of both groups. However, granulations and adhesions did not have a bearing on the success rate in either group. CONCLUSION Mitomycin C did not appear to influence the occurrence of granulations, synechiae, or obliterative sclerosis, nor did it alter the success rate significantly.
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Affiliation(s)
- Thomas Prasannaraj
- Department of Otorhinolaryngology, R.L. Jalappa Hospital and Research Centre, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education, Tamaka, Kolar, India.
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Hanioka Y, Yamagami K, Yoshioka K, Nakamura T, Kishida M, Nakamura T, Yamaguchi T, Koshimo N, Inoue T, Imanishi M. Churg-Strauss syndrome concomitant with chronic symmetrical dacryoadenitis suggesting Mikulicz's disease. Intern Med 2012; 51:2457-61. [PMID: 22975568 DOI: 10.2169/internalmedicine.51.7725] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [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] [Indexed: 11/06/2022] Open
Abstract
A case of Churg-Strauss syndrome complicated by chronic symmetrical dacryoadenitis suggestive of Mikulicz's disease is herein presented. A 72-year-old Japanese man, who had been previously diagnosed with asthma, presented with weakness of the left leg and purpura on the lower extremities. A neurological examination showed multiple mononeuropathies and a laboratory examination revealed elevated eosinophil counts, IgE levels and the presence of Myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCAs). Churg-Strauss syndrome was diagnosed, although the patient also exhibited bilateral swelling of the lachrymal glands. Furthermore, elevated serum IgG4 levels, an infiltration of a relatively large number of IgG4-positive plasmacytes in the nasal mucosa and hypocomplementemia were also observed. These findings were consistent with a diagnosis of Mikulicz's disease (MD). Oral prednisolone (30 mg) was administered and the swelling of the lachrymal glands resolved. Churg-Strauss syndrome may be accompanied by Mikulicz's disease (an IgG4-related disease), and common pathogeneses between Churg-Strauss syndrome and IgG4-related disease may exist.
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Affiliation(s)
- Yusuke Hanioka
- Department of Internal Medicine, Osaka City General Hospital, Japan.
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Abstract
Acute dacryocystitis is a rare complication of infectious mononucleosis with only three previous reports in the English literature. We present two further children with acute dacryocystitis and clinical and laboratory features of Epstein-Barr Virus related infectious mononucleosis. Both were treated with systemic antibiotics and one child additionally required surgical drainage of a lacrimal sac abscess. Both children made a complete recovery without any lacrimal symptoms. Acute dacryocystitis is uncommon in children without a history of congenital nasolacrimal duct obstruction, and an underlying systemic condition such as infectious mononucleosis should be suspected. In such patients, dacryocystitis can be expected to resolve without symptoms of nasolacrimal duct obstruction and dacryocystorhinostomy is seldom required.
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Abstract
An autoimmune pancreatitis (AIP) patient with metachronous and multiple extrapancreatic lesions is reported. Initial symptoms were proptosis, oculomotor deficits, and a visual field deficit of the left eye, and swelling of bilateral lacrimal glands. Swelling of the right salivary gland and elevated serum levels of hepatobiliary enzymes were detected. AIP associated with IgG4-related orbital pseudotumor, IgG4-related sclerosing dacryoadenitis and sialadenitis, and IgG4-related sclerosing cholangitis was diagnosed. All symptoms and lesions improved with steroid therapy. Although an orbital pseudotumor is a rare extrapancreatic lesion of AIP, we should know that AIP patients may describe unusual symptoms such as abnormal visual field.
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Affiliation(s)
- Kensuke Takuma
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Japan
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Pornpanich K, Uiprasertkul M, Luemsamran P, Jantharaworamet B, Vangveeravong S. Entomophthoramycosis: a rare fungal orbital infection presenting with dacryocystitis. Orbit 2011; 30:21-23. [PMID: 21281074 DOI: 10.3109/01676830.2010.535640] [Citation(s) in RCA: 6] [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] [Indexed: 05/30/2023]
Abstract
We report a case of a rare fungal orbital infection in an infant presenting with dacryocystitis. The causative organism was Conidiobolus sp. of the order Entomophthorales. There is no standard treatment for entomophthoramycosis. Our patient responded well to combined antifungal therapy without aggressive surgical débridement.
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Affiliation(s)
- Kanograt Pornpanich
- Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Gregory ME, Macdonald ECA, Lockington D, Ramaesh K. Recurrent fungal keratitis following penetrating keratoplasty: an unusual source of infection. ACTA ACUST UNITED AC 2010; 128:1490-1. [PMID: 21060054 DOI: 10.1001/archophthalmol.2010.264] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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38
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Chen VM. Enlarging red swelling below the right eye. What's your diagnosis? Diagnosis: Congenital dacryocystocele with acute dacryocystitis. J Pediatr Ophthalmol Strabismus 2010; 47:74, 100. [PMID: 20349896 DOI: 10.3928/01913913-20100308-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sun H, Zhao JY, Yan QC, Zhang JS, Chen B, Lin L. [Pathogens distribution and drug sensitivity of infantile dacryocystitis]. Zhonghua Yan Ke Za Zhi 2010; 46:34-37. [PMID: 20388320] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To investigate the pathogens and drug tolerance of infantile dacryocystitis in order to provide evidence for clinical drug use. METHODS 230 cases of infant dacryocystitis (aged from 2 to 10 months, average 90 days) were analyzed for bacterial culture and drug sensitivity tests. These tests were performed following National Guide to Clinical Laboratory Procedures. Based on the results, analyzed the difference of pathogens in different year, the pathogens kind of dacryocystitis, main pathogens of infantile dacryocystitis, average isolation rate of pathogens and sensitive or resistance drug for pathogens. RESULTS Average detecting rate was 87.0% (200 cases). There is no difference for detecting rate in each year. The pathogens were predominantly gram-positive coccus 74.5% (149 cases), coagulase-negative staphylococcus 20.5% (41 cases) and staphylococcus aureus 11.0% (22 cases). Majority of these bacteria were sensitive to tobramycin, ciprofloxacin and levofloxacin. Gram-positive coccus was sensitive to tobramycin and levofloxacin. For gram-negative rod, tobramycin and chloromycetin were most sensitive drug. The sensitivity rates were 96.67% (29 cases). The resistant rates to erythromycin and penicillin were 66.67% (20 cases) and 80.00% (24 cases). CONCLUSION Coagulase-negative staphylococcus was the main pathogen of infantile dacryocystitis.
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Affiliation(s)
- Hong Sun
- Department of Ophthalmology, Shenyang Children's Hospital, Shenyang 110032, China
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Kebede A, Adamu Y, Bejiga A. Bacteriological study of dacryocystitis among patients attending in Menelik II Hospital, Addis Ababa, Ethiopia. Ethiop Med J 2010; 48:29-33. [PMID: 20607995] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Dacryocystitis usually results from blockage of the nasolacrimal duct. The treatment of such obstruction is surgery. There is a fivefold risk of soft tissue infection after open lacrimal surgery without systemic antibiotic prophylaxis that represents a significant risk of failure in lacrimal surgery. PURPOSE To determine the current bacteriology of dacryocystitis and their sensitivity to different antibiotics at Menelik II Hospital. METHOD Consecutive patients with dacryocystitis who presented to the department of ophthalmology at Menelik II Hospital between May 2004 and September 2005 were included in the study. Each patient was sent for culture and sensitivity test. Culture and sensitivity tests were obtained from Ethiopian National Health Research Institute (ENHRI), Arsho, Black Lion and Emmanuel Higher clinic laboratories. RESULTS One hundred fourteen patients, 58 (50.9%) males and 56 (49.1%) females, with dacryocystitis were examined The majority of cases, 82 (71.9%), were under 30 years of age. Positive results were obtained from 91 (79.8%) patients. Gram-positive and gram negative organisms were isolated from 57 (62.6%) and 34 (37.4%) samples respectively. The five most common isolates were Streptococcus pneumoniae (23%), Streptococcus pyogens (14.3%), Staphylococcus aureus (12.1%), Streptococcus viridans (9.9%) and Haemophilus influenzae (9.9%). The antibiotics to which the majority of the isolates sensitive to were chloramphenicol (82.4%), gentamycin (79.1%), erythromycin (68.1%) and tetracycline (61.5%). While Streptococcus pneumoniae was sensitive to chloramphenicol in 95.2%. its sensitivity to tetracycline was 100%. Haemophilus influenzae was sensitive to tetracycline and chloramphenicol in 88.9% and 77.8% respectively. CONCLUSION Gram positive organisms were the most common causes of dacryocystitis. Streptococcus pneumoniae and Haemophilus Influenza was the commonest gram positive and gram negative organisms identified respectively. Chloramphenicol and tetracycline were effective against these common organisms and are recommended for the clinical treatment of dacryocystitis.
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Affiliation(s)
- Aster Kebede
- Addis Ababa Medical Faculty, Department Ophthalmology, Addis Ababa, Ethiopia
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Lu Z, Li J, Ba J, Yang G, Dou J, Mu Y, Lu J. Lymphocytic hypophysitis with dacryoadenitis in a male patient: non-invasive diagnosis and high-dose methylprednisolone pulse therapy. Neuro Endocrinol Lett 2009; 30:700-704. [PMID: 20038929] [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] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 12/08/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Lymphocytic hypophysitis (LH) is a rare autoimmune disorder associated with lymphocytic cell infiltration of the pituitary. It is often detected in patients with other autoimmune systemic diseases such as Hashimoto's thyroiditis, epinephritis, megaloblastic anemia, and Langerhans cell histiocytosis. Pituitary biopsy and invasive histopathological examination provide the most reliable evidence for LH diagnosis. However, because glucocorticoids are extensively used for the treatment of disease, pathological diagnosis is not always necessary. Here, we report a rare case of a male patient (50 y) with LH associated with dacryoadenitis that was successfully treated with high-dose of methylprednisolone. RESULTS The patient had a history of swollen lacrimal glands for two years. In addition, magnetic resonance imaging (MRI) showed a markedly thickened infundibular stem and an indiscernible signal in the posterior lobe of the pituitary. Biopsy of the lacrimal glands revealed reactive hyperplasia of the lymphoid tissue. After a high-dose of methylprednisolone pulse treatment (HDMPT), lacrimal gland swelling and infundibular stem thickness were reduced, and adenopituitary function improved within a short time period. CONCLUSIONS Although association of LH with dacryoadenitis is a rare, it can be effectively managed with HDMPT. In addition, response to HDMPT can avoid the more invasive diagnostic procedures, including surgical intervention and pituitary biopsies.
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Affiliation(s)
- Zhaohui Lu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, P. R. China
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Halawa A, Yacoub G, Al Hassan M, Byrd RP, Roy TM. Dacryocystitis: an unusual form of Mucorales infection. J Ky Med Assoc 2008; 106:520-524. [PMID: 19058477] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Mucormycosis is an acute fungal infection in humans that is often fulminant and potentially fatal. It occurs most frequently in immunocompromised individuals. We report a diabetic patient who presented in ketoacidosis with lacrimal sac infection from this organism. To the best of our knowledge, this is only the second patient with dacryocystitis caused by this fungus described in the medical literature. Our patient is unique in that she had no evidence of concurrent sinus involvement. Surgical debridement and antifungal therapy were combined to ensure a successful outcome.
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Affiliation(s)
- Ahmad Halawa
- James H. Quillen Veterans Affairs Medical Center, Mountain Home, TN 37684-4000, USA
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Mills DM, Bodman MG, Meyer DR, Morton AD. The microbiologic spectrum of dacryocystitis: a national study of acute versus chronic infection. Ophthalmic Plast Reconstr Surg 2007; 23:302-6. [PMID: 17667103 DOI: 10.1097/iop.0b013e318070d237] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine the microbiologic spectrum of dacryocystitis, specifically characterizing differences between acute and chronic infection. METHODS National multicenter prospective study of the microbiologic spectrum of acute and chronic dacryocystitis based on culture results reported between March 2005 and March 2006. Chi-square analysis was used to compare differences between groups. RESULTS Eighty-nine patients from 16 centers were included: 21 (23.6%) patients had acute infection and 68 (76.4%) had chronic infection. Of all 89 patients, there were 80 total culture isolates with 55 (68.8%) Gram-positive isolates, 23 (28.7%) Gram-negative isolates, and 2 (2.5%) Mycobacterium isolates. In the acute group, 18/23 (78.3%) were Gram-positive and 5/23 (21.7%) were Gram-negative. In the chronic group, 37/57 (64.9%) were Gram-positive, 18/57 (31.6%) were Gram-negative, and 2/57 (3.5%) were Mycobacterium isolates. The proportions of Gram-positive and Gram-negative organisms between groups revealed no statistically significant difference (p > 0.20). The frequency of methicillin-resistant Staphylococcus aureus (MRSA) in the acute group, 4/23 (17.4%), was greater than the chronic group, 1/57 (1.8%) (p < or = 0.01). CONCLUSIONS Gram-positive organisms were much more common than Gram-negative organisms overall, and the proportions did not differ significantly between the groups. Staphylococcus was the most common isolate in both groups, but there was a greater frequency of methicillin-resistant Staphylococcus aureus (MRSA) isolates in the acute group. The results of this study have important implications for the treatment of dacryocystitis.
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Affiliation(s)
- David M Mills
- Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical Center, Albany, New York 12159, USA
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47
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Zois G. [Dacryocystitis]. MMW Fortschr Med 2007; 149:5. [PMID: 18027414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Georgios Zois
- Facharzt für Allgemeinmedizin, Implerstrasse 38, D-81371 München
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Dielmann K, Zeier M. Bilaterale Dakryoadenitis. Dtsch Med Wochenschr 2007; 132:1827-8. [PMID: 17726654 DOI: 10.1055/s-2007-984972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- K Dielmann
- Abteilung Innere Medizin I, Sektion Nephrologie, Medizinische Universitätsklinik Heidelberg, Germany
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Nishiyama T, Mishima K, Obara K, Inoue H, Doi T, Kondo S, Saka M, Tabunoki Y, Hattori Y, Kodama T, Tsubota K, Saito I. Amelioration of lacrimal gland inflammation by oral administration of K-13182 in Sjögren's syndrome model mice. Clin Exp Immunol 2007; 149:586-95. [PMID: 17614971 PMCID: PMC2219315 DOI: 10.1111/j.1365-2249.2007.03448.x] [Citation(s) in RCA: 8] [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] [Indexed: 11/29/2022] Open
Abstract
Regulation of the adhesion of mononuclear cells to endothelial cells is considered to be a critical step for the treatment of inflammatory diseases, including autoimmune diseases. K-13182 was identified as a novel inhibitor for these adhesions. K-13182 inhibited the expression of vascular cell adhesion molecule-1 (VCAM-1, CD106) on human umbilical vein endothelial cells (HUVECs) and on mouse vascular endothelial cell line (MAECs) induced by tumour necrosis factor (TNF)-alpha. K-13182 also inhibited the adhesion of mononuclear cells to these HUVECs and MAECs, indicating that K-13182 suppressed these adhesions mediated by cellular adhesion molecules including VCAM-1. To evaluate the therapeutic effect in autoimmune disease model mice, K-13182 was orally administered to non-obese diabetic (NOD) mice as Sjögren's syndrome (SS) model mice. Severe destructive inflammatory lesions were observed in the lacrimal glands of vehicle-treated control mice; however, 8-week administration of K-13182 inhibited the mononuclear cell infiltration into the inflammatory lesions of the lacrimal glands. In K-13182-treated mice, the decrease in tear secretion was also prevented compared to the control mice. In addition, the apoptosis and the expression of FasL (CD178), perforin, and granzyme A was suppressed in the lacrimal glands of K-13182-treated mice. Therefore, K-13182 demonstrated the possibility of therapeutic efficacy for the inflammatory region of autoimmune disease model mice. These data reveal that VCAM-1 is a promising target molecule for the treatment of autoimmune diseases as a therapeutic strategy and that K-13182 has the potential as a new anti-inflammatory drug for SS.
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Affiliation(s)
- T Nishiyama
- Department of Pathology, Tsurumi University School of Dental Medicine, Yokohama, Japan; Sjögren's Syndrome Project, Shinanomachi Research Park, Keio University, Tokyo, Japan
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Ahmed M, Niffenegger JH, Jakobiec FA, Ben-Arie-Weintrob Y, Gion N, Androudi S, Folberg R, Raizman MB, Margo CE, Smith ME, McLean IW, Caya JG, Foster CS. Diagnosis of limited ophthalmic wegener granulomatosis: distinctive pathologic features with ANCA test confirmation. Int Ophthalmol 2007; 28:35-46. [PMID: 17589807 DOI: 10.1007/s10792-007-9109-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [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: 02/18/2007] [Accepted: 05/14/2007] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the clinical and histopathologic finding of very limited ophthalmic Wegener granulomatosis (WG). METHODS Thirteen patients with scleritis, orbitopathy, episcleritis, and panuveitis were studied. They presented without evidence of lung or kidney disease, though eight had sinus involvement. We reviewed the biopsies for histopathologic findings consistent with WG, and tested for antineutrophil cytoplasmic antibodies antineutrophil cytoplasmic antibody (ANCA). RESULTS WG was suggested by granulomatous foci, collagen necrosis, neutrophils/nuclear dust, plasma cells and infiltrating eosinophils. Granular degeneration of the interstitial collagen; mummification of the collagen with disappearance of fibroblastic nuclei; and a polymorphous infiltrate exhibiting plasma cells, lymphocytes, neutrophils, and eosinophils within the epithelioid granulomas should suggest the diagnosis. ANCA test results supported the diagnosis of WG in all cases. CONCLUSION The described histologic characteristics are highly suggestive of WG. These findings along with clinical or laboratory findings, allow the diagnosis of very limited ophthalmic WG in the absence of systemic involvement.
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Affiliation(s)
- Muna Ahmed
- Massachusetts Eye Research & Surgery Institute, Harvard Medical School, 8th Floor, 5 Cambridge Center, Cambridge, MA 02142, USA
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