Combined Intravitreal and Systemic Antibiotic Therapy in a Patient with Syphilitic Uveitis

Purpose: To report the novel use of combined intravitreal and systemic antibiotic therapy in a patient with syphilitic panuveitis and discuss the management of ocular syphilis.

Methods: Case report

Results: A 45-year old heterosexual male with human immunodeficiency virus (HIV) presented with 1 month of blurry vision in both eyes. Clinical examination revealed a bilateral panuveitis. The patient denied history of genital lesions or rash, but did complain of difficulty hearing bilaterally. Treponemal EIA was positive, the RPR titer greater than 1:512 dilution, and CSF VDRL 1:4. A diagnosis of neurosyphilis and ocular syphilis was made based on the clinical and laboratory findings. The patient was admitted for systemic intravenous antibiotic therapy, but was noted to have a penicillin allergy. Intravitreal ceftazidime was promptly administered bilaterally to achieve treponemacidal levels of antibiotic therapy. After penicillin desensitization protocol, the patient received 14 days of intravenous penicillin with clinical resolution.

Conclusions: There are increasing reports of ocular syphilis in the United States and delay in diagnosis and management can lead to severe visual impairment and blindness. We report the first case of adjunct intravitreal antibiotic therapy in a penicillin allergic patient. As ocular syphilis is a form of bacterial endophthalmitis, combination intravitreal and systemic antibiotics may be considered.     

A rare case of a periorbital respiratory (choristomatous) cyst

Respiratory cysts are benign lesions lined by normal respiratory epithelium. There are few reported cases localized to the orbit, while those of the eyelid are exceedingly rare. Respiratory cysts usually arise either from a non‐hereditary congenital malformation, where they are distinguished as choristomatous, or from trauma. Here, we report a case of a 53‐year‐old man who presented with a large right lower eyelid cyst that was histopathologically diagnosed as a respiratory cyst.     

Spitz melanocytic tumours – a review

Spitz tumours comprise a spectrum of melanocytic proliferations that share a set of distinct cytological features and molecular pathways. They include benign naevi, intermediate or indeterminate tumours and rare melanomas. Spitz tumours are notorious for the difficulty of distinguishing benign neoplasms with atypical features from melanomas and the related diagnostic uncertainty. Advances in the knowledge of the molecular pathways and genomic aberrations associated with these neoplasms have permitted opportunities for a reduction in the number of uncertain diagnoses and a more objective distinction between Spitz tumours from Spitz-like neoplasms. The presence of a Spitz molecular pathway, such as Harvey rat sarcoma viral oncogene homologue (HRAS) aberrations or kinase fusions, distinguishes a bona fide Spitz neoplasm from Spitz-like naevi or melanomas with conventional driver mutations. Spitz neoplasms with benign histopathological features and, if such testing is performed, benign cytogenetic and molecular findings, are termed Spitz naevi. Spitz neoplasms with frankly malignant histopathological findings or ambiguous microscopic findings associated with genetic or genomic aberrations most in keeping with melanoma are designated as Spitz melanoma. Tumours with microscopic features and genetic/genomic aberrations in between naevi and melanomas are classified as Spitz melanocytoma.     

Hidden risks in toys: A systematic review of pediatric toy contact dermatitis

Toys are a reflection of the compounds used frequently in manufacturing. Allergic contact dermatitis to potties, metal toys, and children's jewelry is well known, however, there is a broad range of skin risks in toys. With the objective to identify and publicize the associated risk of contact dermatitis in children's toys, we have searched the PubMed database from creation to September 9, 2019. Studies were eligible if they reported a new case of contact dermatitis secondary to interaction with a toy in patients from birth to 18 years of age. A toy was defined as something children interact with for entertainment during leisure time. In this review of the PubMed database we filtered by age and language which may have prevented us from detecting cases in adults that could be extrapolated to children. In addition, several articles were excluded based on title alone. A total of 1312 articles were identified and reviewed manually for inclusion criteria. Review of the articles found 25 original articles for consideration. Several toys were found to be associated with contact dermatitis. These included electronics, toy cars, costume jewelry, bicycles, sqwish balls, slime, Play-Doh, and plasticine. Electronics such as video game controllers, cellphones, iPads, and computers were implicated. In conclusion, there is still an unmet need for observation of this segment of industry for labeling of contents and ongoing surveillance.