MyMedR

Fulltext Unilateral frosted branch angiitis in an human immunodeficiency virus-infected patient with concurrent COVID-19 infection: a case report

Lim TH, Wai YZ, Chong JC

J Med Case Rep, 2021 May 12;15(1):267.

PMID: 33980269 DOI: 10.1186/s13256-021-02826-1

BACKGROUND: Frosted branch angiitis (FBA) is an uncommon ocular sign with multiple causes. With the recent outbreak of coronavirus disease 2019 (COVID-19), many cases of ocular manifestation in association with this disease have been reported. However, as yet we have no complete understanding of this condition. We report here the first case of FBA in a human immunodeficiency virus-infected patient with coexisting cytomegalovirus (CMV) and COVID-19 infection.

CASE PRESENTATION: A 33-year-old Malay man with underlying acquired immunodeficiency syndrome receiving highly active antiretroviral therapy was referred to the Opthalmology Department with complaints of blurry vision for the past 2 months. He had tested positive for and been diagnosed with COVID-19 1 month previously. Clinical examination of the fundus revealed extensive perivascular sheathing of both the artery and vein suggestive of FBA in the right eye. Laboratory testing of nasal swabs for COVID-19 polymerase chain reaction (PCR) and serum CMV antibody were positive. The patient was then admitted to the COVID-19 ward and treated with intravenous ganciclovir.

CONCLUSION: Clinicians should be aware of and take the necessary standard precautions for possible coexistence of COVID-19 in an immunocompromised patient presenting with blurred vision, eye redness, dry eye and foreign body sensation despite the absence of clinical features suggestive of COVID-19. Whether FBA is one of the ocular signs of co-infection of COVID-19 and CMV remains unknown. Further studies are needed to provide more information on ocular signs presented in patients with concurrent COVID-19 and CMV infections.

Matched MeSH terms: Retinal Vasculitis*

Clinical features and prognostic factors of cutaneous vasculitis among dermatology patients in Johor Bahru, Malaysia

Latha S, Choon SE, Tey KE, Chee YN

Med J Malaysia, 2017 12;72(6):345-349.

PMID: 29308771 MyJurnal

BACKGROUND: Cutaneous vasculitis is common, yet the risk factors for its chronicity have not been established.

OBJECTIVE: To describe the clinical spectrum and identify risk factors for chronicity of cutaneous vasculitis.

METHODS: Retrospective data analysis of 275 patients diagnosed with cutaneous vasculitis from January 2008 to December 2013.

RESULTS: The mean age was 33.7 (±17.89) years, with female predominance. The majority of patients were Malays (67.3%). Skin biopsy was performed in 110 (40%) patients. The commonest sign was palpable purpura (30.6%). The aetiology remained elusive in 51.3% of patients. Common identifiable causes include infection (19.7%) and connective tissue disease (10.2%). Extracutaneous features were noted in 46.5% of patients. Erythrocyte sedimentation rate and antinuclear antibody were raised in 124 of 170 and 27 of 175 patients with documented results respectively. Cutaneous vasculitis was the presenting symptom in seven patients with newly diagnosed systemic lupus erythematosus. Anti Streptolysin O Titre was positive in 82 of 156 patients with documented results. Despite antibiotics, 31.7% of them had chronic lesions. Prednisolone alone was used in 20% of patients while 16.4% needed steroid-sparing agents. Most patients who needed systemic therapy (62%) had unidentifiable aetiology. Among the 155 patients who remained under follow up, 36.4% had chronic disease, one patient succumbed due to septicaemia, and the rest fully recovered within three months. The presence of ulcerative lesion was significantly associated with developing chronic vasculitis (p=0.003).

CONCLUSION: The clinical spectrum of cutaneous vasculitis in our population was similar to other studies. Ulcerative lesion predicts a chronic outcome.

Matched MeSH terms: Vasculitis/diagnosis*; Vasculitis/drug therapy; Vasculitis/etiology; Vasculitis/physiopathology*

Fulltext Optic neuritis and retinal vasculitis as primary manifestations of systemic lupus erythematosus

Barkeh HJ, Muhaya M

Med J Malaysia, 2002 Dec;57(4):490-2.

PMID: 12733176

Systemic lupus erythematosus (SLE) is a common multisystem disorder. However, retinal vasculitis as a primary manifestation of SLE is uncommon, accounting for only 4% of causes of retinal vasculitis. The postulated mechanism appeared to be vaso-occlusion of the retinal arterioles by thrombosis, with resultant ischaemia. Optic neuropathy in SLE is also rare, with a prevalence of 1%. This is a case report of a young lady who presented to us with retinal vasculitis as her initial presentation of SLE. Interestingly, the pathologic mechanism appeared to be inflammatory and not vaso-occlusive.

Matched MeSH terms: Retinal Vasculitis/diagnosis*; Retinal Vasculitis/etiology*; Retinal Vasculitis/therapy

Hemorrhagic bullous Henoch- Schonlein purpura: a case report

Nirmala Ponnuthurai, Sabeera Begum, Lee, Bang Rom

Malaysian Journal of Paediatrics and Child Health, 2016;22(101):0-0.

MyJurnal

Henoch – Schonlein purpura (HSP) is a vasculitis of small sized blood vessels. It is the most common acute systemic vasculitis in childhood. It mainly affects skin, gastrointestinal tract, joints and kidney. It results from Immunoglobulin A mediated inflammation. The characteristic skin findings are palpable purpuric lesions over the lower limbs and buttocks. The occurance of haemorrhagic bullae in children with HSP is rarely encountered. This case report describes a 12 year old boy with bullous haemorrhagic HSP treated at Institute Paediatric, Hospital Kuala Lumpur.

Matched MeSH terms: Vasculitis

Fulltext Acute haemorrhagic oedema of infancy with bullae and koebnerisation

Mohd Sazlly Lim S, Shamsudin N

Malays Fam Physician, 2014;9(2):55-7.

PMID: 25883766 MyJurnal

A 5-month-old Malay boy presented with purpuric papules and plaques on the face and extremities accompanied by fever, coryzal symptoms and bilateral lower limb oedema. There were also bullous linear purpuric lesions on the right upper limb. Blood and culture tests were normal. Histopathological tests showed leucocytoclastic vasculitis, confirming the diagnosis of acute haemorrhagic oedema of infancy. The patient achieved complete recovery after 2 weeks with no recurrence.

Matched MeSH terms: Vasculitis, Leukocytoclastic, Cutaneous

Fulltext Dengue fever presenting as bilateral dengue maculopathy

Umi Kalthum, M.N.

Medicine & Health, 2012;7(1):57-61.

MyJurnal

Dengue fever is a common pyrexial-viral infection in the Asian region and the incidence is increasing yearly. There are various ocular manifestations of dengue fever such as maculopathy, retinal hemorrhages, retinal lesions and vasculitis. Reduction in visual acuity and other visual disturbances such as metamorphopsia is the most common presentation of dengue-associated maculopathy. We report an interesting case of a young lady with bilateral maculopathy secondary to dengue fever who was managed conservatively with dramatic visual improvements. This case highlights the possibility of bilateral and simultaneous ocular involvements in patients infected with dengue fever. Both ophthalmologists and physicians need to be aware of ocular complications following dengue fever and advice patients regarding the symptoms.

Matched MeSH terms: Vasculitis

Fulltext Cutaneous vasculitis: a review of aetiology and clinical manifestations in 85 patients in Malaysia

Muthupalaniappen L, Aziz SA, Gangaram HB, Hussein SH

Med J Malaysia, 2009 Sep;64(3):210-2.

PMID: 20527269 MyJurnal

Cutaneous vasculitis presents with a variety of clinical morphologies and causes significant morbidity. A total of 85 patients with cutaneous vasculitis at Hospital Kuala Lumpur were retrospectively reviewed. Palpable purpura was seen in 49.4% and frequently involved the lower limbs (50.6%). Identifiable causes include drugs (28.2%), infections (20.0%) and connective tissue disorders (16.5%). Non steroidal antiinflammatory were the commonest group of drugs responsible for 25% of cases while B-haemolytic streptococci was the leading infectious cause (64.7%).

Matched MeSH terms: Vasculitis/etiology*; Vasculitis/epidemiology

Fulltext Tuberculous retinal vasculitis

Hoh HB, Kong VY, Jaais F

Med J Malaysia, 1998 Sep;53(3):288-9.

PMID: 10968169

A patient who was referred to the eye department for routine ocular assessment prior to commencement of antituberculous therapy was found to have periphlebitis in both eyes despite being visually asymptomatic. Fluorescein angiography confirms the presence of vasculitis without any retinal oedema or areas of non-perfusion, which may sometimes accompany the condition. Within 2 months of systemic treatment, the ocular signs regressed without any permanent effect on vision. This case highlights a rare ocular complication associated with systemic tuberculosis which fortunately did not result in loss of vision due to prompt treatment.

Matched MeSH terms: Vasculitis/microbiology*; Vasculitis/pathology

Fulltext Neurological manifestations of children with systemic lupus erythematosus

Loh WF, Hussain IMI, Soffiah A, Lim YN

Med J Malaysia, 2000 Dec;55(4):459-63.

PMID: 11221157

In a cross-sectional study of 21 children with Systemic Lupus Erythematosus, 15 (71%) were found to have neuropsychiatric manifestations. The most common finding was generalised seizures (42.8%) followed by encephalopathy (19%) and hallucinations (19%). One child (4.76%) had hemichorea. In 3 children neurological manifestations were the first symptom of SLE. Computerised Axial Tomograms (CAT scans) showed cerebral atrophy in 7 of 12 scans available for review. Ten children had abnormal EEGs. Although none of the children had clinical evidence of a peripheral neuropathy, 8 had neurophysiological evidence of a neuropathy. One child died of intracranial haemorrhage. Six children had residual neuropsychiatric sequalae.

Matched MeSH terms: Lupus Vasculitis, Central Nervous System/complications; Lupus Vasculitis, Central Nervous System/diagnosis; Lupus Vasculitis, Central Nervous System/epidemiology*; Lupus Vasculitis, Central Nervous System/physiopathology

Retinal phlebitis associated with autoimmune hemolytic anemia

Chew FL, Tajunisah I

Ocul Immunol Inflamm, 2009 Nov-Dec;17(6):394-5.

PMID: 20001258 DOI: 10.3109/09273940903260204

To describe a case of retinal phlebitis associated with autoimmune hemolytic anemia.

Matched MeSH terms: Retinal Vasculitis/diagnosis; Retinal Vasculitis/etiology*

Lingual myoclonus and neuropsychiatric lupus: a new association?

Ong SG, Chua R

Int J Rheum Dis, 2014 Jun;17(5):583-5.

PMID: 24330407 DOI: 10.1111/1756-185X.12260

Matched MeSH terms: Lupus Vasculitis, Central Nervous System; Lupus Vasculitis, Central Nervous System/complications*; Lupus Vasculitis, Central Nervous System/diagnosis; Lupus Vasculitis, Central Nervous System/drug therapy

The Collaborative Ocular Tuberculosis Study (COTS) Consensus (CON) Group Meeting Proceedings

Agrawal R, Testi I, Mahajan S, Yuen YS, Agarwal A, Rousselot A, et al.

Ocul Immunol Inflamm, 2020 Apr 06.

PMID: 32250731 DOI: 10.1080/09273948.2020.1716025

An international, expert led consensus initiative was set up by the Collaborative Ocular Tuberculosis Study (COTS) group to develop systematic, evidence, and experience-based recommendations for the treatment of ocular TB using a modified Delphi technique process. In the first round of Delphi, the group identified clinical scenarios pertinent to ocular TB based on five clinical phenotypes (anterior uveitis, intermediate uveitis, choroiditis, retinal vasculitis, and panuveitis). Using an interactive online questionnaires, guided by background knowledge from published literature, 486 consensus statements for initiating ATT were generated and deliberated amongst 81 global uveitis experts. The median score of five was considered reaching consensus for initiating ATT. The median score of four was tabled for deliberation through Delphi round 2 in a face-to-face meeting. This report describes the methodology adopted and followed through the consensus process, which help elucidate the guidelines for initiating ATT in patients with choroidal TB.

Matched MeSH terms: Retinal Vasculitis

Fulltext Streptococcus pneumoniae Meningitis and Intracranial Vasculopathy: Clinical Correlation with Improving Transcranial Doppler Hemodynamics

Idris MI, Tai SML, Tan CT, Tan KS

Case Rep Neurol, 2020 12 14;12(Suppl 1):106-109.

PMID: 33505281 DOI: 10.1159/000500950

Streptococcus pneumoniae are Gram-positive bacteria that are responsible for many types of illnesses including pneumonia, sinus infections, and community-acquired meningitis. One important complication of bacterial meningitis is intracranial vasculopathy. Possible etiologies include vasculitis, vasospasm, endocarditis, or intra-arterial thrombosis. We present a case report of S. pneumoniae meningitis treated with antibiotics in which clinical improvement correlated with serial transcranial Doppler ultrasonography (TCD) improvement, suggesting vasospasm or vasculitis as a possible mechanism for intracranial vasculopathy.

Matched MeSH terms: Vasculitis

Fulltext Two cases of retinal vasculitis in ocular tuberculosis involving different parts of the vascular system

Kok, Howe Sen, Tara, Mary Georg, Mae-Lynn, Catherine Bastion, Muhaya Hj Mohamad

Medicine & Health, 2006;1(1):91-93.

MyJurnal

Two case reports of retinal vasculitis in presumptive ocular tuberculosis are presented. Case 1 is a 26-year-old Malay woman who had phlebitis with choroidal lesions and case 2 is a 27 year old Malay woman who had occlusive arteritis. Both subjects had positive Mantoux tests with negative systemic screen. Both responded clinically to anti-tuberculous therapy within days of commencing therapy. There was however concurrent increase in vitritis which decreased following anti-inflammatory doses of oral corticosteroids. These two cases represent a rare mode of presentation of ocular tuberculosis for which a high index of suspicion is needed. Multidrug anti-tuberculous therapy should be combined with oral corticosteroids for effective treatment.

Matched MeSH terms: Retinal Vasculitis

Fulltext Primary angiitis of the central nervous system with myelopathy as initial clinical presentation

Cheng, Yin Tan, Lingam, Ganeshwara, Suhailah Abdullah, Ai, Huey Tan, Tai, Sharon Mei-Ling, Norlisah Ramli, et al.

Neurology Asia, 2015;20(1):79-84.

MyJurnal

Primary angiitis of the central nervous system (PACNS) is a rare vasculitis restricted to the central nervous system without systemic involvement. Delay in diagnosis and treatment is common due to its non-specific symptoms and lack of non-invasive diagnostic tests. Myelopathy can occur in PACNS, during the clinical course of the illness, with or without cerebral symptoms. We describe here a 51 year-old ethnic Chinese woman who presented initially with paraparesis without cerebral symptoms. The diagnosis of PACNS was eventually made from brain biopsy when she subsequently developed cerebral involvement. Despite aggressive treatment, the patient developed progressive neurological deterioration and died. This patient demonstrates the rare occurrence of myelopathy as the sole initial presentation of PACNS.

Matched MeSH terms: Vasculitis, Central Nervous System

Fulltext Pathological laughter associated with cerebral lupus: a case report

Singh J, Ahmad N, Chai YC

ASEAN Journal of Psychiatry, 2017;18(1):107-113.

MyJurnal

Objective: Pathological laughter, pseudobulbar affect or a myriad of its other synonyms, is a condition common secondary to neurological injury, presenting with uncontrolled laughing or crying, appearing to be mood-incongruent and significantly debilitating. The objective of this case report is to highlight a rare case of pathological laughter associated with Cerebral Lupus.
Methods: We report a case of a 27-year-old lady presenting with signs and symptoms of stroke with dysarthria progressing to aphasia and then pathological laughter, with an underlying poorly controlled Systemic Lupus Erythematosus, manifesting as Cerebral Lupus.
Results: An improvement in affect congruency followed by decreased frequency of outbreaks among bouts of pathological laughter.
Conclusion: The combination of Escitalopram and Topiramate is effective in the symptomatic treatment of Pathological Laughter.

Matched MeSH terms: Lupus Vasculitis, Central Nervous System

"Fleshy" Skin Cellulitis: A Triggering Factor for ANCA Associated Vasculitis

Yang SC, Mustafar R, Kamaruzaman L, Wei Yen K, Mohd R, Cader R

Acta Med Indones, 2019 Oct;51(4):338-343.

PMID: 32041918

A 59-year-old lady with underlying hypothyroidism presented with acute contact dermatitis progressed to cellulitis with superimposed bacterial infection and acute kidney injury. She responded to initial management with antibiotics, but a week later, she had cutaneous and systemic vasculitis. Her skin biopsy consistent with immune-mediated leuko-cytoclastic vasculitis and her blood test was positive for cytoplasmic-anti-neutrophil cytoplasmic antibody (c-ANCA). A diagnosis of ANCA-associated vasculitis was made and she was treated with immunosuppressant with plasmapheresis and hemodialysis support for her kidney failure. Despite aggressive measures, the patient succumbed to her illness. This case report demonstrates that soft tissue infection could trigger the development of ANCA-associated vasculitis whilst a background of hypothyroidism serves as a predisposing factor as both condition were reported separately in a couple of case studies before.

Matched MeSH terms: Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/complications; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis*; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy

Macula retinal vasculitis and choroiditis associated with granulomatosis with polyangiitis

Lim LT, Vasudevan V, Shelton J, Vitale AT, Moorthy R

Retin Cases Brief Rep, 2017 Spring;11(2):119-122.

PMID: 27305849 DOI: 10.1097/ICB.0000000000000307

PURPOSE: To report a case series of two cases of granulomatosis with polyangiitis, previously known as Wegener granulomatosis, which developed macular necrosis, not previously associated with granulomatosis with polyangiitis, healed with fibrosis, despite aggressive immune-modulating therapy and good control of systemic disease.

METHODS: Case series of two cases with observation of treatment progress.

RESULTS: The results reported the progress of response to treatment in the two cases, which resulted in the final outcome of fibrosis in the macula region, despite being on aggressive immune-modulating therapy and good systemic control.

CONCLUSION: Granulomatosis with polyangiitis can be associated with macular necrosis leading to fibrosis, unresponsive to immune-modulating therapy.

Matched MeSH terms: Retinal Vasculitis/etiology*

Necrotizing angiitis of the small intestine related to AA-amyloidosis: a novel association

Oweity T, West AB, Stokes MB

Int. J. Surg. Pathol., 2001 Apr;9(2):149-54.

PMID: 11484503

A 71-year-old man with intestinal pseudo-obstruction was found to have a diffusely thickened adynamic small bowel with AA-amyloid in submucosal vessels and muscularis propria, foreign body giant cell reaction to amyloid, and necrotizing angiitis. The mucosa was unremarkable. Immunostains demonstrated numerous CD68+ monocyte/macrophages and CD8+ T cells associated with the amyloid deposits. The patient had no evidence of systemic vasculitis and no underlying cause for AA-amyloidosis was identified. Necrotizing angiitis coexistent with amyloid angiopathy has been reported in brain and temporal arteries, but not in the gastrointestinal tract and not with AA-amyloid. The inflammatory cell infiltrates in this case are consistent with a foreign-body and/or cell-mediated immunologic reaction to AA-amyloid, although a role for these cells in amyloid formation cannot be excluded.

Matched MeSH terms: Vasculitis/pathology*

Fulltext Cerebral infarction pattern in tuberculous meningitis

Tai MS, Viswanathan S, Rahmat K, Nor HM, Kadir KA, Goh KJ, et al.

Sci Rep, 2016 12 13;6:38802.

PMID: 27958312 DOI: 10.1038/srep38802

Tuberculous meningitis (TBM) causes significant morbidity and mortality. The primary objective was to re-examine the concept of "TB zone" and "ischaemic zone" in cerebral infarction in patients with tuberculous meningitis. The secondary objective was to evaluate cerebral infarction, vasculitis and vasospasm in tuberculous meningitis infections. Between 2009 and 2014, TBM patients were recruited. Neuroimaging was performed and findings of cerebral infarction, vasculitis and vasospasm were recorded. Infarcts were classified based on arterial supply and Hsieh's classification. Fifty-one TBM patients were recruited of whom 34 patients (67%) had cerebral infarction. Based on Hsieh's classification, 20 patients (59%) had infarcts in both "TB zone" and "ischaemic zones". 12 patients (35%) had infarcts in "ischaemic zone" and two (6%) patients had infarcts in "TB zone". In terms of vascular supply, almost all patients (35/36) had infarcts involving perforators and cortical branches. 25 patients (73%) and 14 patients (41%) had infarcts supplied by lateral lenticulostriate and medial lenticulostriate arteries respectively. 15 patients (37%) had vasculitis. Vasospasm was present in six patients (15%). 29 patients (85%) with cerebral infarction also had leptomeningeal enhancement (p = 0.002). In summary, infarcts involved mainly perforators and cortical branches, rather than "TB zone" versus "ischaemic zone".

Matched MeSH terms: Vasculitis/complications

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