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*

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

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*

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 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

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*

Fulltext Ocular Tuberculosis Initially Presenting as Central Retinal Vein Occlusion

Mahyudin M, Choo MM, Ramli NM, Omar SS

Case Rep Ophthalmol, 2010 Aug 02;1(1):30-35.

PMID: 21116342

A 23-year-old man presented with central retinal vein occlusion. The retinal haemorrhages worsened and signs of retinal vasculitis appeared later as vision dropped from 6/60 to Counting Fingers. No signs of systemic disease were observed. Routine Mantoux test and chest radiograph were negative for tuberculosis. Fundus flourescein angiogram confirmed presence of retinal vasculitis. Both systemic and topical corticosteroid therapy were ineffective. Polymerase chain reaction analysis of vitreous fluid showed presence of Mycobacterium tuberculosis. A full 6-month course of antituberculosis therapy was given and inflammation subsided. Vision improved to 3/60. This is a rare case of ocular tuberculosis without evidence of systemic infection, presenting first as a central retinal vein occlusion.

Matched MeSH terms: Retinal Vasculitis

Fulltext Silent occlusive retinal vasculitis in a patient with pulmonary tuberculosis

Nadia Yaacob, Adil Hussein, Maizan Yaakob, Zuraidah Mustari

Journal of Biomedical and Clinical Sciences, 2018;3(1):31-34.

MyJurnal

The presence of retinal vasculitis in patients with pulmonary tuberculosis is not uncommon. However, asymptomatic presentations are quite rare. Here, we present a case of 25-year-old Malay gentleman with pulmonary tuberculosis, who was referred for an eye assessment following initiation of anti-tuberculosis drugs. His vision was good; he had no other symptoms despite having retinal neovascularization, pre-retinal haemorrhages and healed choroiditis at the fundus of the left eye. Fundus fluorescein angiography showed multiple areas of capillary fallouts at the superotemporal quadrant of the left eye with leakage from the retinal neovascularization. He was treated with laser retinal photocoagulation and oral steroids for 6 weeks, while the anti-tuberculosis drugs were continued for 9 months. Subsequent follow-ups showed regression of the neovascularization. He has remained asymptomatic since his initial visit to the eye clinic.

Matched MeSH terms: Retinal Vasculitis

Fulltext Bilateral retinal vasculitis: a presumed case of ocular TB without inflammation

Umi Kalthum, M.N., Norfarizal, A., Rona Asnida, N., Ayesha, M.Z., Jemaima, C.H.

Medicine & Health, 2012;7(2):97-101.

MyJurnal

A 17-year-old male student of Indonesian parentage presented with two weeks history of progressive painless bilateral visual deterioration. There was no contact with tuberculosis (TB)-infected patients and parents claimed that all immunization including BCG was completed. However, BCG scar was not apparent. Visual acuity was 6/36 and 6/60 in the right and left eyes respectively. The anterior and vitreous chambers were quiet. Funduscopic examination revealed retinal vasculitis with perivascular exudates, branch vein occlusion, neovascularization and macular oedema. Fluorescein angiography confirmed large areas of capillary non-perfusion and leaking new vessels. Mantoux test was positive and full regime anti-TB therapy was instituted. HIV screening was negative. Three days later, an immunosuppressive dose of oral steroid was started. Both eyes received intensive laser photocoagulation.Interestingly, there was no development of vitritis throughout.

Matched MeSH terms: Retinal Vasculitis

Fulltext Successful visual outcome following vitrectomy for complication of ocular tuberculosis

Norshamsiah, M.D., Muhaya, M., Bastion, M.L.C.

Journal of Surgical Academia, 2012;2(2):56-59.

MyJurnal

A 24-year-old Chinese gentleman presented with two weeks history of sudden floaters in his right temporal visual field associated with blurring of vision. This ex-smoker also reported chronic, bloody cough for two years and recent pleuritic chest pain. Examination revealed a thin patient with right eye visual acuity of 6/18 associated with optic nerve dysfunction, optic disc swelling and macula star, retinal vasculitis and retinitis. Despite anti-tuberculosis medication and corticosteroids, he developed neovascularisation. Subsequent vitreous haemorrhage necessitated trans pars plana vitrectomy, membrane peeling, endolaser and silicone oil injection. Final visual acuity was 6/9 with quiescent retinopathy.

Matched MeSH terms: Retinal Vasculitis

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