Presentation
To describe the clinical presentation and course of Whipple disease in an adult. A 34-year-old man with phthisis bulbi in the right eye secondary to uveitis-induced neovascular glaucoma presented with severe acute posterior uveitis in the left eye. [ncbi.nlm.nih.gov]
Entire Body System
- Cushingoid
Cushingoid stigmata worsened after administration of posterior subtenon injection of corticosteroids. The patient's truncal obesity worsened, and his linear growth stopped. [ncbi.nlm.nih.gov]
- Intermittent Fever
Patient 12, a 38-year-old man, developed gradually progressive vision failure, severe headaches, and intermittent fevers during the last few months of a jail sentence. [academic.oup.com]
Eyes
- Eye Pain
Uveitis is inflammation of the middle layer of the eye, called the uvea or uveal tract. It can cause eye pain and changes to your vision. Most cases get better with treatment – usually steroid medicine. [nhs.uk]
Overview Uveitis is a form of eye inflammation. It affects the middle layer of tissue in the eye wall (uvea). Uveitis (u-vee-I-tis) warning signs often come on suddenly and get worse quickly. They include eye redness, pain and blurred vision. [mayoclinic.org]
Mydriatic eye drops, such as atropine or cyclopentolate, dilate the pupil and help the eye to heal. It also helps with eye pain and stops the pupil from sticking to the lens. [medicalnewstoday.com]
- Visual Acuity Decreased
However, thereafter the visual acuity decreases again. Cataract and elevated IOP are common side effects. [ncbi.nlm.nih.gov]
Visual acuity may be decreased. Extraocular movement: generally normal. [patient.info]
Psychiatrical
- Loss of Initiative
[…] if treatment is not initiated promptly, and rates of visual impairment or vision loss are high. [retinatoday.com]
Neurologic
- Macropsia
Symptoms CHOROIDITIS is a painless condition but visual symptoms d/t vitreouse haze and retinal involvement Visual symptoms Defective vision Photopsia Floaters Metamorphosia Micropsia Macropsia Positive scotoma 12. Sign Ant. [slideshare.net]
- Micropsia
Symptoms CHOROIDITIS is a painless condition but visual symptoms d/t vitreouse haze and retinal involvement Visual symptoms Defective vision Photopsia Floaters Metamorphosia Micropsia Macropsia Positive scotoma 12. Sign Ant. [slideshare.net]
Workup
Workup ultimately revealed ocular syphilis, and neurosyphilis was additionally confirmed with cerebrospinal fluid studies. Treatment with intravenous penicillin was promptly initiated with complete visual recovery. [ncbi.nlm.nih.gov]
Designed for quick point-of-care reference, the book features numerous full-color photographs and bulleted how-to instructions for workup and treatment of each disorder. [books.google.com]
(eg, HIV, toxoplasmosis), depending on the presentation See Workup for more detail. [emedicine.medscape.com]
[…] of any suspected underlying systemic condition Ophthalmoscopic examination Leukocytes in the vitreous humor and vitreous opacity Foci of inflammation of the choroid and/or retina Further workup of any suspected underlying systemic condition Complications [amboss.com]
X-Ray
- Multiple Pulmonary Nodules
The chest roentgenogram showed multiple pulmonary nodules throughout both lung fields. No definitive diagnosis was established either by brushing cytology or biopsy through bronchoscopy or percutaneous needle biopsy. [ncbi.nlm.nih.gov]
Microbiology
- Herpes Simplex Virus Type 2
Acute retinal necrosis caused by herpes simplex virus type 2 in children: reactivation of an undiagnosed latent neonatal herpes infection. Semin Pediatr Neurol. 2012;19(3):115–8. [PMC free article] [PubMed] [Google Scholar] 77. [ncbi.nlm.nih.gov]
HLA Type
- HLA-DR2
Account for 10% of all uveitis -Bimodal distribution Etiology – -Idiopathic (HLA-DR2) 85% -Known cause(15%) TB, Syphilis, Sarcoidosis and Lyme disease. 6. Sign Ant. [slideshare.net]
Treatment
One patient developed ocular and systemic tuberculosis, which responded to antituberculous treatment. Infliximab is effective in the treatment of sight-threatening refractory posterior uveitis. [ncbi.nlm.nih.gov]
Prognosis
A good prognosis can be expected for those who undergo appropriate treatment. The condition can lead to permanent blindness if left undiagnosed or untreated Complications, such as glaucoma and cataract, can worsen the prognosis. [dovemed.com]
In addition, preliminary data indicate that fundus autofluorescence characteristics may serve as markers of disease activity, allow prediction of visual prognosis, and may help determine the adequacy of therapy. [ncbi.nlm.nih.gov]
The clinical characteristics and visual prognosis did not reveal statistically significant difference compared to the patients with anterior uveitis. [iovs.arvojournals.org]
Etiology
Introduction Uveitis represents a heterogeneous group of intraocular inflammatory diseases with a diverse set of infectious and noninfectious etiologies. [dovepress.com]
The diagnosis and treatment of the underlying systemic disease may be useful at the management of the visual and systemic complications Key Words: Pediatric üveitis, etiology, complication, treatmentKeywords: pediatric üveitis, etiology, complication, [journalagent.com]
Since some of these infections may respond well to antiviral therapy, it is important to work up all cases of posterior uveitis to rule out an infectious etiology. [ncbi.nlm.nih.gov]
Other causes for a focal retinitis include infectious etiologies such as toxoplasmosis, acute retinal necrosis, cysticercosis or onchocerciasis.[82–85] A history of immunosuppression should suggest unusual etiologies such as CMV, retinitis, or progressive [medscape.com]
Posterior Uveitis: Advances in Imaging and Treatment focuses on the ocular imaging modalities used in the diagnosis of various uveitis and intraocular inflammation entities resulting from infectious and non-infectious etiologies. [amazon.com]
Epidemiology
Nakae K, Masaki F, Hashimoto T, et al (1992) A nation-wide epidemiological survey on Behçet’s disease, report 2: association of HLA-B51 with clinico-epidemiological features. Report of Behçet’s Disease Research Committee. [link.springer.com]
Uveitis epidemiology varies widely with geographic location; however, it remains a significant cause of vision loss throughout the world. [dovepress.com]
From the *Department of Ophthalmology and the †Department of Medicine, The Johns Hopkins University School of Medicine, and the ‡Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. [journals.lww.com]
Vadot E (1992) Epidemiology of intermediate uveitis: a prospective study in Savoy. Dev Ophthalmol 23:33–34 PubMed 7. Tran VT et al (1994) Epidemiological characteristics of uveitis in Switzerland. Int Ophthalmol 18(5):293–298 PubMed CrossRef 8. [springermedizin.de]
Epidemiology: This clinical syndrome is encountered frequently. Pathogenesis: The pathogen,Toxoplasma gondii, is transmittedby ingestionof tissue cysts in raw or undercooked meat or by oocysts from cat feces. [brainkart.com]
Pathophysiology
[…] iris Etiology Vascular hypoxia (e.g., central retinal vein occlusion, central retinal artery occlusion, temporal arteritis) Neural diseases (e.g., diabetic retinopathy) Inflammatory (e.g., chronic uveitis) Neoplasms of the eye (e.g., uveal melanoma) Pathophysiology [amboss.com]
Pathophysiology As there are different forms of scleritis, the pathophysiology is also varied. Scleritis associated with autoimmune disease is characterized by zonal necrosis of the sclera surrounded by granulomatous inflammation and vasculitis. [eyewiki.aao.org]
Non-neoplastic: retinitis pigmentosa intraocular foreign body juvenile xanthogranuloma retinal detachment Neoplastic: retinoblastoma lymphoma malignant melanoma leukemia reticulum cell sarcoma Pathophysiology[edit] Immunologic factors[edit] Onset of uveitis [en.wikipedia.org]
Clinical trial data on these and other potential therapies will enhance understanding of the pathophysiology of NIU of the posterior segment, and one or more of these agents may in the future provide additional therapeutic options for patients. n 1. de [retinatoday.com]
Pathophysiology Autoimmune reaction (similar to Episcleritis and Scleritis ) Uveitis may occur in isolation or as part of a systemic inflammatory condition (see causes below) Diagnosis is as a result of spillover inflammation into the aqueous and vitreous [fpnotebook.com]
Prevention
There are no current guidelines to prevent posterior uveitis. [lahey.org]
Treatment Goals Symptom Relief – Pain, photophobia, blurred vision Prevent Visual Loss Prevent Complications 14. Treatment 1. [pt.slideshare.net]