Chorioretinitis induced by intravesical Bacillus Calmette-Guérin (BCG) instillations for urinary bladder carcinoma

BACKGROUND: We report the rare case of a chorioretinitis occurring after intravesical BCG instillation to cure in situ carcinoma. HISTORY AND SIGNS: A 57-year-old man was treated for bladder carcinoma with BCG instillations. Visual acuity was 20/20 in the right eye and 20/40 in the left eye. Bilateral chorioretinitis was discovered three months after initiation of intravesical BCG therapy. THERAPY AND OUTCOME: No progression of ocular lesions could be seen after a 6 months therapy with rifampicin, isoniazide and ethambutol. CONCLUSIONS: BCG chorioretinitis is a rare complication that can be seen after intravesical BCG therapy. BCG is a live attenuated strain of Mycobacterium bovis. Two mechanisms can be proposed as the origin of ocular inflammation: a local immune response or a direct choroidal mycobacterial infection.     

Acute pseudoseptic arthritis and palmoplantar pustulosis

Summary The case of a 60-year-old woman who developed acute peripheral arthritis of a pseudoseptic character (high synovial leucocytosis and fever) associated to a palmoplantar pustulosis is reported.     

Serum Protein Electrophoresis: Any role in monitoring for Antiretroviral Therapy?

Background

Developing world are always looking for monitoring tools during reagent shortage and equipments troubles which are very frequent. The aim of this study was to evaluate Serum Protein Electrophoresis (SPE) as a marker for assessing HIV treatment response.

Methods

A cross-sectional study was conducted with 220 participants in four distinct groups: Symptomatic HIV positive patients [specifically those on antiretroviral treatment (ART) versus those not on ART] asymptomatic HIV positive patients, and healthy blood donors. Five serum protein fractions (Albumin, Alpha-1, Alpha-2, Beta, and Gamma) were compared between these groups after measuring the density of the fractions.

Results

Concentration of gamma globulin was lowest among healthy blood donors, intermediate and comparable among asymptomatic HIV positive and symptomatic HIV positive on ART and highest among untreated symptomatic HIV positive. Concentration of gamma globulin was inversely correlated with the disease stage (p < 0.001).

Conclusion

In this study, conducted in a setting where the burden of infectious diseases is high, the density of gamma globulin and albumin fractions were significantly associated with HIV status, and among HIV positive patients, with stage of HIV disease and ART. These results suggest that the feasibility of using SPE for monitoring the response of ART in low resource settings should be further explored.