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Altman MT, Staubach Z, Dunlap J, Zaki A, Skalet AH, Leonard J, Lin P. PSEUDOPANUVEITIS AS A HARBINGER FOR SYSTEMIC LEUKEMIA RECURRENCE. Retin Cases Brief Rep 2023; 17:117-119. [PMID: 34081042 PMCID: PMC10421638 DOI: 10.1097/icb.0000000000001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a patient with a history of pre-B-cell acute lymphoblastic leukemia in remission, who developed recurrent alternating intraocular leukemia manifesting with pseudohypopyon, uveal mass, and serous retinal detachment. In multiple instances, this constellation of ocular findings preceded systemic leukemia recurrence. METHOD Case report. RESULTS A 29-year-old man with a history of pre-B-cell acute lymphoblastic leukemia, in remission after a hematopoietic stem cell transplant, presented with pseudohypopyon, uveal lesions, and serous retinal detachment of the right eye. Comprehensive workup for infectious and inflammatory etiologies was unremarkable, and a bone marrow biopsy revealed systemic recurrence of leukemia. One year later, while again in remission, the patient developed a pseudohypopyon, uveal mass, and serous retinal detachment of the other eye. Repeat bone marrow biopsy showed impending leukemia relapse, which occurred 1 month later. Orbital radiation resulted in complete ocular resolution. CONCLUSION The constellation of pseudohypopyon, serous retinal detachment, and uveal mass (pseudopanuveitis) should be recognized as a harbinger for systemic pre-B ALL recurrence.
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Affiliation(s)
| | - Zane Staubach
- Department of Pathology, Oregon Health & Science University, Portland, Oregon
| | - Jennifer Dunlap
- Department of Pathology, Oregon Health & Science University, Portland, Oregon
| | - Amr Zaki
- Casey Eye Institute, Oregon Health & Science University
| | - Alison H. Skalet
- Casey Eye Institute, Oregon Health & Science University
- Department of Radiation Medicine, Oregon Health & Science University
- Department of Dermatology, Oregon Health & Science University
| | - Jessica Leonard
- Department of Hematology and Medical Oncology, Oregon Health & Science University
| | - Phoebe Lin
- Casey Eye Institute, Oregon Health & Science University
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Alhazzani AA, Tobaigy MF, Aldofyan MI, AlBloushi AF. Peripheral Subretinal Mass Complicating Necrotizing Anterior Scleritis in a Patient with Granulomatosis with Polyangiitis. Middle East Afr J Ophthalmol 2022; 29:159-162. [PMID: 37408726 PMCID: PMC10319073 DOI: 10.4103/meajo.meajo_180_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/05/2023] [Accepted: 03/13/2023] [Indexed: 07/07/2023] Open
Abstract
Anterior scleritis is rarely diagnosed with a peripheral amelanotic subretinal mass. We reported a rare case of a 31-year-old woman who was referred for suspected left eye choroidal melanoma. The patient had granulomatosis with polyangiitis with a history of treated left eye necrotizing anterior scleritis. Her left eye examination revealed 20/60 vision, superotemporal diffuse scleral injection, and thinning. Dilated fundus examination of the left eye showed a large peripheral amelanotic subretinal mass below the area of anterior scleritis, optic disc hyperemia, and subretinal fluid. The patient was successfully treated with intravenous methylprednisolone, rituximab infusions, and oral methotrexate. Two months after treatment, her vision improved to 20/20, with inactive anterior scleritis and a significant reduction in the subretinal mass with complete resolution of optic disc hyperemia and subretinal fluid. High index of suspicion of this atypical presentation of anterior scleritis is important to avoid aggressive modalities of treatment.
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Affiliation(s)
- Abeer A. Alhazzani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohanned F. Tobaigy
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Munirah I. Aldofyan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Babu N, Kumar K, Upadhayay A, Kohli P. Nodular posterior scleritis - The great masquerader. Taiwan J Ophthalmol 2021; 11:408-412. [PMID: 35070674 PMCID: PMC8757530 DOI: 10.4103/tjo.tjo_20_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/28/2021] [Indexed: 12/02/2022] Open
Abstract
We aim to report the management of a patient who presented with a choroidal mass masquerading as an amelanotic choroidal melanoma. A 57-year-old male presented with defective vision in his right eye, which was associated with mild periocular pain. Fundus examination showed a large dome-shaped yellowish-orange subretinal mass in the macular region and exudative retinal detachment (RD). Magnetic resonance imaging (MRI) showed a 16 mm × 8 mm choroidal mass, which was hyperintense on T1-weighted images and hypointense on T2-weighted images. B-scan ultrasonography revealed a dome-shaped mass with homogeneous echogenicity, inferior RD, and fluid collection in the sub-Tenon space. There was no choroidal excavation. He was diagnosed as nodular posterior scleritis (NPS) with exudative RD in the right eye. The lesion regressed completely after treatment with oral steroids. Choroidal mass can pose a diagnostic dilemma to ophthalmologists. Atypical MRI features can further augment the confusion. Despite its low incidence, NPS should always be kept as a differential in the presence of an amelanotic choroidal mass.
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Affiliation(s)
- Naresh Babu
- Department of Vitreo-Retinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Karthik Kumar
- Department of Vitreo-Retinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Anubhav Upadhayay
- Department of Vitreo-Retinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Piyush Kohli
- Department of Vitreo-Retinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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Shariff S, Teo KSS, Hitam WHW. Choroidal mass secondary to mucinous cystadenocarcinoma of ovary in a young woman: a life-threatening metastasis. Rom J Ophthalmol 2021; 65:196-200. [PMID: 34179588 PMCID: PMC8207865 DOI: 10.22336/rjo.2021.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To report a case of choroidal mass secondary to mucinous cystadenocarcinoma of ovary in a young woman. Method: A case report. Result: A 21-year-old woman presented with insidious painless, progressive, central scotoma of the right eye for 5 weeks. She was disease free for 9 years after she underwent right salpingo-oophorectomy for her mucinous cystadenocarcinoma of right ovary. She completed 6 cycles of chemotherapy regimen. On presentation, her visual acuity was counting finger in the right eye and 6/ 6 in the left eye. Both anterior segments were unremarkable. Fundus examination of the right eye showed multiple choroidal masses with the largest in the temporal to fovea. Generally, she was well. Her tumor markers were raised. Urgent Computed Tomography (CT) Scan of thorax, abdomen and pelvis showed multiple distance metastases. She was referred to the gynecology team. She was scheduled for chemotherapy. However, she defaulted the treatment. 3 months after that, her general condition deteriorated. She developed bilateral internal jugular vein thrombosis and massive right pleural effusion. She passed away due to that complication. Conclusion: Choroidal metastasis from primary ovary carcinoma is very rare. Ocular symptoms can be the first presenting features to a life-threatening condition.
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Affiliation(s)
- Saidatulakma Shariff
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Health Campus, Universiti Sains Malaysia; Hospital Universiti Sains Malaysia, Malaysia
| | - Khairy Shamel Sonny Teo
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Health Campus, Universiti Sains Malaysia; Hospital Universiti Sains Malaysia, Malaysia
| | - Wan Hazabbah Wan Hitam
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Health Campus, Universiti Sains Malaysia; Hospital Universiti Sains Malaysia, Malaysia
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Kita M, Kagitani Y, Hama S, Azumi A. Sub-Tenon Injection of Triamcinolone Acetonide for Choroidal Mass in Sarcoidosis: A Case Report. Int Med Case Rep J 2021; 14:33-38. [PMID: 33542662 PMCID: PMC7853417 DOI: 10.2147/imcrj.s294488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/31/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To report the clinical course of a sub-tenon injection of triamcinolone acetonide for treatment of an asymptomatic choroidal mass in sarcoidosis. Methods This was a retrospective, non-comparative interventional case study. Results A 36-year-old Japanese man with sarcoidosis presented with an asymptomatic choroidal mass lesion associated with subretinal fluid accumulation in his left eye, but without any other sign of intraocular inflammation in either of his eyes. He had started systemic steroid administration for thrombocytopenia 2 days prior to being examined. After a single sub-tenon injection of triamcinolone acetonide (20 mg) the subretinal fluid was completely absorbed and the choroidal granuloma began to shrink in size. After the injection, the granuloma became a scar without any complication or recurrence over the next 34 months. Conclusion Sub-tenon injection of triamcinolone acetonide might be an effective treatment for choroidal granuloma in sarcoidosis.
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Affiliation(s)
- Mihori Kita
- Department of Ophthalmology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yu Kagitani
- Department of Ophthalmology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Sachiyo Hama
- Department of Ophthalmology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Atsushi Azumi
- Department of Ophthalmology, Kobe Kaisei Hospital, Kobe, Japan
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Abstract
Choroidal tuberculoma is a rare ocular form of tuberculosis (TB) that raises both a diagnostic and a therapeutical challenge, especially when occurring without other manifestations of the disease. This study reports the case of a 27-year-old woman who had a unilateral drop of vision (20/100) with ocular pain. Her fundus examination revealed an elevated juxtapapillary choroidal mass measuring 892 µm in diameter, as calculated by optical coherence tomography (OCT), and associated with a serous retinal detachment involving the macula. The diagnosis of choroidal tuberculoma was established by positive QuantiFERON-TB and tuberculin skin test. Laboratory and imaging workup ruled out pulmonary and systemic TB as well as other possible etiologies. Antituberculosis therapy was started and led to an improved visual acuity (20/30) and a shrinkage of the tuberculoma to a diameter of 499 µm at 3 months. This is one of the few reported cases of solitary choroidal tuberculoma in a patient with no other sign of TB. It sheds light on the place of OCT in the diagnosis and follow-up of the choroidal mass, in terms of measuring the size of the mass and revealing the associated serous retinal detachment and the distinctive “contact sign” between the neurosensory retina and the retinal pigment epithelium (RPE)–choriocapillaris layer surmounting the tuberculoma.
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Affiliation(s)
- Nicolas Arej
- Department of Ophthalmology, Faculty of Medicine, Saint-Joseph University, Beirut; Department of Ophthalmology, Eye and Ear Hospital International, Dbayeh
| | - Ali Fadlallah
- Department of Ophthalmology, Faculty of Medicine, Saint-Joseph University, Beirut; Department of Ophthalmology, Eye and Ear Hospital International, Dbayeh
| | - Elias Chelala
- Department of Ophthalmology, Faculty of Medicine, Saint-Joseph University, Beirut; Department of Ophthalmology, Hôtel-Dieu de France Hospital, Beirut, Lebanon
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Abstract
A 72-year-old man presented after a single choroidal mass was incidentally detected on fundus examination of his right eye. The patient has a history of multiple myeloma and neuroendocrine thymoma diagnosed 6 and 10 years before presentation, respectively. Fine-needle aspiration biopsy revealed metastatic choroidal carcinoid tumor. The patient was subsequently treated with brachytherapy (iodine-125).
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Affiliation(s)
- Hassan A Aziz
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Joseph N Martel
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Charles V Biscotti
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Arun D Singh
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Carol L Shields
- Department of Ophthalmology, Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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Hage R, Jean-Charles A, Guyomarch J, Rahimian O, Donnio A, Merle H. Nodular posterior scleritis mimicking choroidal metastasis: a report of two cases. Clin Ophthalmol 2011; 5:877-80. [PMID: 21760715 PMCID: PMC3133004 DOI: 10.2147/opth.s21255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Indexed: 11/23/2022] Open
Abstract
Posterior scleritis is a rare underdiagnosed condition that can potentially cause blindness. Its varied presentations lead to delayed or incorrect treatment. We present here the cases of two patients with nodular posterior scleritis mimicking a choroidal metastasis. Two female patients presented with a sudden unilateral visual loss associated with ocular pain. Fundus examination revealed temporomacular choroidal masses with exudative detachments that, due to angiographic presentation, were suggestive of choroidal metastasis. Systemic examinations were unremarkable. In the two cases, a local or general anti-inflammatory treatment led to the complete recovery of the lesions, which were, thus, considered nodular posterior scleritis. The diagnosis of nodular posterior scleritis has to be evoked in all patients presenting with a choroidal mass in fundus examination. It represents the principal curable differential diagnosis of malignant choroidal tumor.
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Affiliation(s)
- Rabih Hage
- Department of Ophthalmology, University Hospital of Fort-de-France, Martinique, French West Indies
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