levoleucovorin and Optic-Nerve-Diseases

To report a case of bilateral optic disc oedema and associated optic neuropathy in the setting of FOLFOX chemotherapy.. A case of a 57-year-old male being treated with FOLFOX chemotherapy for stage 3B colorectal cancer, who developed bilateral optic disc oedema and associated left sided optic neuropathy is described. The patient presented following cycles 7, 8 and 9 of chemotherapy with a history of bilateral simultaneous intermittent inferior altitudinal field defects. These episodes progressed to bilateral optic nerve oedema and a subsequent left sided optic neuropathy. The patient's symptoms and oedema regressed with discontinuation of chemotherapy.. This is the first report suggesting a vasospastic role of 5-fluoruracil in 5-FU associated optic neuropathy. It highlights that 5-FU may have the potential to cause arterial vasospasm outside the cardiac vasculature, resulting in end-organ optic nerve ischaemia.

Topics: Antineoplastic Combined Chemotherapy Protocols; Colorectal Neoplasms; Fluorouracil; Humans; Leucovorin; Male; Middle Aged; Optic Nerve Diseases; Organoplatinum Compounds; Papilledema

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Colonic Neoplasms; Colonoscopy; Combined Modality Therapy; Electroretinography; Evoked Potentials, Visual; Female; Fluorouracil; Humans; Leucovorin; Middle Aged; Optic Nerve Diseases; Organoplatinum Compounds; Paraneoplastic Syndromes, Ocular; Radiotherapy; Retinal Diseases; Vision Disorders; Visual Acuity; Visual Field Tests; Visual Fields

To report a case of toxoplasmosis with optic nerve and orbital involvement as the initial presentation of HIV infection.. Case report.. A 46-year-old zookeeper, who had had right central retinal vein occlusion (CRVO) 2 weeks previously, presented with painless lid and conjunctival swelling and profound visual loss in his right eye (RE). Examination revealed no light perception (NLP) RE with axial proptosis and ocular motility restriction; fundal examination revealed a clinical picture of an ischaemic CRVO. MRI of the brain and orbit showed ring-enhancing targetoid lesions in the brain and inflammatory changes in the right optic nerve, extraocular muscles and orbital fat. He was subsequently found to be HIV positive and had positive toxoplasma IgG serology.. Immunocompromised individuals have an increased likelihood for more severe and atypical presentations; this highlights the need for increased index of suspicion for HIV infection as ocular or orbital disease may be the first manifestation of life-threatening systemic toxoplasmosis.

Topics: AIDS-Related Opportunistic Infections; Anti-Retroviral Agents; Blepharitis; CD4 Lymphocyte Count; Conjunctivitis; Drug Therapy, Combination; HIV Seropositivity; Humans; Leucovorin; Magnetic Resonance Imaging; Male; Methylprednisolone; Middle Aged; Optic Nerve Diseases; Orbital Pseudotumor; Pyrimethamine; Retinal Vein Occlusion; Sulfadiazine; Toxoplasmosis, Ocular