Bilateral Kuttner Tumours of the Lacrimal Glands

Kuttner Tumour is a chronic inflammatory disease diagnosed histologically. It is under-diagnosed due to lack of awareness of the disease. We present a case of a 40-year old female with recurrent upper lid swelling. Biopsy revealed the diagnosis of Kuttner Tumours of the lacrimal glands. Although surgical excision is a treatment option, it can be treated with a course of steroids. Our patient opted for conservative management. We describe the presentation and course of the case, with an emphasis on the histological features of the tumour.     

Unusual involvement of IgG4-related sclerosing disease in lacrimal and submandibular glands and extraocular muscles

Chronic sclerosing sialadenitis, also known as Kuttner tumor, is a chronic inflammatory disease of the salivary glands that is reported in a few cases in medical literature. Recent reports suggest that certain aspects of sclerosing diseases, including chronic sclerosing sialadenitis or dacryoadenitis, should be classified under immunoglobulin G4 (IgG4)-related sclerosing disease based on immunohistochemical studies. This study reports an unusual case of IgG4-related sclerosing disease appearing simultaneously in the lacrimal glands, submandibular glands, and extraocular muscles. A 56-year-old male presented with complaints of bilateral eyelid swelling and proptosis that began two years ago. Computed tomography confirmed that bilateral submandibular enlargements also existed five years ago in the subject. Orbital computed tomography and magnetic resonance imaging revealed bilateral lacrimal gland enlargement and thickening of extraocular muscles. Typical findings of chronic sclerosing dacryoadenitis were revealed upon pathologic exam of the right lacrimal gland. Immunostaining revealed numerous IgG4-positive plasma cells. Through these clinical features, we make a diagnosis of IgG4-relataed sclerosing disease in the subject.     

A case of Rosai-Dorfman disease involving the lacrimal gland in an elderly patient

Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) is a rare disease characterised by benign proliferation of histiocytes, with painless lymph node enlargement and frequent extranodal involvement. Orbital involvement occurs in 11% of cases and onset of the disease is typically in the first two decades of life. A benign course is usual, but in some cases blindness or fatality may result. We present a case with late onset at age 78 years and lacrimal gland involvement, and review the literature on this disease.     

A case of Rosai-Dorfman disease involving the lacrimal gland in an elderly patient

Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) is a rare disease characterised by benign proliferation of histiocytes, with painless lymph node enlargement and frequent extranodal involvement. Orbital involvement occurs in 11% of cases and onset of the disease is typically in the first two decades of life. A benign course is usual, but in some cases blindness or fatality may result. We present a case with late onset at age 78 years and lacrimal gland involvement, and review the literature on this disease.     

Optic neuropathy in Hodgkin's disease.

Hodgkin's disease is a rare cause of infiltrative optic neuropathy, which typically evolves late in the disease course. We managed an unusual case of isolated optic neuropathy in a 21-year-old man occurring during clinical remission from Hodgkin's disease. Radiotherapy and treatment with high-dose systemic corticosteroids resulted in dramatic improvement in vision. Even without other evidence of recurrent disease, acute-onset optic neuropathy in a patient with a history of a lymphoproliferative disorder should raise the question of a reemergence of the malignancy.     

Secondary bacterial keratitis in herpes zoster ophthalmicus

We report a case of an unusual complication of herpes zoster ophthalmicus, secondary bacterial keratitis. Compared with previously reported cases, ours is unique in its early occurrence in the course of zoster and the lack of predisposing factors such as steroid use, contact lens use, or prior corneal disease or surgery. The opportunistic pathogen Branhamella cattarhalis responded well to medical therapy. We feel that bacterial superinfection must always be a concern in patients with herpes zoster keratitis, even early in their often prolonged chronic disease.     

Manejo de la hendidura de ciclodiálisis con crioterapia transescleral

A cyclodialysis cleft is a rare disease that is produced as a result of a separation of the longitudinal fibers of the ciliary body muscle from the scleral spur. A stepwise approach is the best course of action to treat cyclodialysis, starting with medical therapy and continuing with more invasive surgical options. We report a case of ocular hypotony due a traumatic cyclodialysis successfully resolved with transscleral cryotherapy.     

Acute dacryoadenitis and Crohn's disease: findings and management.

Concurrent orbital pseudotumor and Crohn's disease, although rare, have been described. To the best of our knowledge, pseudotumor isolated to the lacrimal gland (dacryoadenitis) with concurrent Crohn's disease has never been reported. We present the clinical course and ultrasonographic and radiologic findings of an acute case of isolated bilateral lacrimal gland pseudotumor in a patient with Crohn's disease. The treatment and review of the literature are discussed.     

Orbital and Cavernous Sinus Lymphoma Masquerading as Post-Herpetic Neuralgia

We report an unusual case of adult-onset B-cell lymphoma in the cavernous sinus presenting as post-herpetic neuralgia; additionally, we review the literature regarding primary B-cell lymphomas of the cavernous sinus. This case demonstrates the importance of maintaining a suspicion for malignancy when an atypical clinical course is seen, even when presented with seemingly common or innocuous disease.KEYWORDS: cavernous sinus, lymphoma, post-herpetic neuralgia     

Transmission of herpes simplex during CPR training

Instruction in cardiopulmonary resuscitation (CPR) has become a standard part of training for medical personnel and is widely recommended for the lay public. We present a case report of two women, one of whom contracted herpes labialis and one of whom contracted ocular herpes simultaneously after participating as partners in a CPR training course. This case suggests that added precautions against the transmission of infectious disease should be taken by screening participants in CPR courses for signs of respiratory, oral, or facial cutaneous disease. In addition, this case underscores the crucial importance of adequately disinfecting mannequins between users and between training sessions. Specific recommendations are made.     

Phacoemulsification in total white cataract with Stevens-Johnson syndrome

Cataract surgery with Stevens-Johnson syndrome (S-J) is associated with a high incidence of complications and can worsen the primary disease. We report a case of phacoemulsification of a total, white cataract barely visible through the vascularized, keratinized cornea in the only seeing eye of a patient with S-J syndrome. We describe the intra-operative difficulties encountered during phacoemulsification and the surgical tools and techniques employed to overcome the surgical difficulties. The postoperative course was uneventful and the patient regained useful, navigational vision.     

Hypertensive retinopathy in child with pheochromocytoma

AIM: Pheochromocytoma is a tumor secreting catecholamines, it occurs in different age, rarely in children. The disorder coexists with malignant arterial hypertension. We present a case of patient with ophthalmic alterations in the course of pheochromocytoma. MATERIAL AND METHODS: In 12-year old boy operated on pheochromocytoma full ophthalmic examination, fluorescent angiography and ERG were performed. RESULTS: We found decreased visual acuity, hypertensive retinopathy and the scotopic and fotopic ERG alterations. CONCLUSIONS: Hypertensive retinopathy in the course of pheochromocytoma could be the first symptom of the disease, especially in children. The earlier this disorder is diagnosed and operated on, the better is the prognosis for health and regression of retinal findings.     

Ocular involvement as the initial manifestation of T-cell chronic lymphocytic leukemia

PURPOSE: To present a case of T-cell chronic lymphocytic leukemia (T-CLL) manifesting as an intraocular lymphoma. DESIGN: Interventional case report. METHODS: We performed a vitreous biopsy in a 67-year-old woman who presented with blurred vision and vitreous cellular infiltration. Morphologic, immunohistochemical, flow cytometry, and molecular analysis by polymerase chain reaction of vitreous fluid, peripheral blood, bone marrow aspirate, and biopsy were performed. RESULTS: Cytofluorographic and molecular analysis of vitreous cells demonstrated a monoclonal T-cell population consistent with a T-cell intraocular lymphoma. Systemic evaluation established diagnosis of T-cell CLL. CONCLUSION: T-CLL is a rare disease with an aggressive clinical course. We present a case of T-cell intraocular lymphoma as the initial manifestation of an otherwise asymptomatic T-CLL.     

The value of corticosteroids in the treatment of sterile ulcer in rheumatoid arthritis: a case report

Ocular manifestations of rheumatoid arthritis are mainly dry eye syndrome, scleritis, and keratitis. The occurrence of corneal ulceration in the course of this disease is a rare complication but can lead to ocular perforation. We report the case of a woman followed for rheumatoid arthritis who presented a bilateral sterile paracentral ulcer that responded well to medical treatment.     

A case of Vogt-Koyanagi-Harada disease with good visual acuity in spite of subfoveal fold

BACKGROUND: Vogt-Koyanagi-Harada (VKH) disease patients with the complication of subretinal pigmented proliferative tissue tend to have a poor visual prognosis. CASE: We herein report a case of VKH with good visual acuity despite a prominent subretinal fold. OBSERVATIONS: A 24-year-old woman, who experienced several recurrent episodes of VKH disease, had bilateral serous retinal detachment with poor vision (RE 20/40 and LE 20/25). After the administration of high doses of systemic corticosteroids and D-mannitol, the subretinal fluid disappeared and the sensory retinas gradually became reattached. During the course of therapy, prominent pigmented subretinal strands were formed in both eyes. Optical coherence tomography disclosed that the strands existed at the retinal pigment epithelium level. Amazingly, we observed a change in the location of the fold in the posterior retina during the course of the disease. The patient finally showed the "sunset glow" fundi and a subretinal fold that was located almost directly beneath both fovea. Fortunately, this patient was able to recover and finally achieve a good visual acuity (RE 20/17 and LE 20/17). CONCLUSION: We reported a VKH disease patient with a good visual acuity despite a remarkable subfoveal fold, which changed its location during the course of the disease.     

Creutzfeldt - Jakob presenting with isolated visual symptoms: the Heidenhain variant

CLINICAL CASE: We report the case of a 67 year old female complaining of decreased vision and diagnosed with the Heidenhain variant of sporadic Creutzfeldt-Jakob disease. Her past medical history was unremarkable. She died less than three months after the onset. DISCUSSION: The Heidenhain variant of sporadic Creutfeld-Jakob disease should be suspected in patients suffering from early visual disturbances, unremarkable ophthalmic examination, and subsequent rapid decline of their cognitive function. A complete neurological exam including electroencephalogram recordings and magnetic resonance is mandatory. These patients share a common genotype (PRNP codon 129 MM) associated with a clinically typical disease course.     

Detection of Mycobacterium tuberculosis by polymerase chain reaction in a case of orbital tuberculosis

Orbital tuberculosis is quite uncommon. We report a case of orbital tuberculosis in a 3-year-old child from Bangladesh who presented with swelling and discharging sinus in the lower part of the orbit. Histopathology revealed a granulomatous inflammation with caseation necrosis. Polymerase chain reaction (PCR) showed amplification of the Mycobacterium tuberculosis genome. The patient responded to a course of antituberculous treatment. Mycobacterium tuberculosis should be considered in the differential diagnosis of inflammatory orbital disease in the Indian subcontinent where tuberculosis is prevalent.     

Detection of Mycobacterium tuberculosis by polymerase chain reaction in a case of orbital tuberculosis

Orbital tuberculosis is quite uncommon. We report a case of orbital tuberculosis in a 3-year-old child from Bangladesh who presented with swelling and discharging sinus in the lower part of the orbit. Histopathology revealed a granulomatous inflammation with caseation necrosis. Polymerase chain reaction (PCR) showed amplification of the Mycobacterium tuberculosis genome. The patient responded to a course of antituberculous treatment. Mycobacterium tuberculosis should be considered in the differential diagnosis of inflammatory orbital disease in the Indian subcontinent where tuberculosis is prevalent.     

Retinitis septica Roth--a case report

We report of a case of retinitis septica in a 37-years old man one month after his tooth's extraction. Because of decreased right eye's central vision and a presence of typical retinal Roth's spots we called internists for a possibility of bacterial endocarditis. Cardiologic examination confirmed this disease together with aortal valve's defect. The course of hearth's disease was weary heavy, with attack of septic fever and cardial decompensation. After acute stage control, defocusation and antibiotic therapy, he underwent a surgical intervention with exchange of aortal valve.