meropenem and Macular-Edema

Kikuchi-Fujimoto disease (KFD) is a histiocytic necrotising lymphadenitis characterised by painful cervical lymphadenopathy, fever, malaise and weight loss. Infections, auto-immune pathogenesis and a genetic association have been implicated. A 12-year-old boy presented with a 1-month history of fever, abdominal pain, constipation and weight loss, and a painful lymph node was detected in the right axilla. Chest CT demonstrated multiple lymph nodes, especially in the left mediastinum. Salmonella enteritidis group D was detected in a blood culture and he was treated with ceftriaxone, followed by meropenem. An axillary lymph node biopsy demonstrated necrotising histiocytic lymphadenitis and KFD was diagnosed. He was discharged 35 days after admission. He was re-admitted 3 weeks later with recurrence of symptoms and headache and was found to have papilloedema of the left eye and auto-immune thyroiditis. Intravenous immunoglobulin (IVIG) 400 mg/kg/day was administered for 5 days. The fever and papilloedema slowly resolved and, subsequently, the thyroiditis, and he has remained well on follow-up. This is the first report of an association of S. enteritidis infection and papilloedema with KFD. IVIG may be required in prolonged or recurrent cases and in those with an auto-immune association.

Topics: Anti-Bacterial Agents; Biopsy; Blood; Ceftriaxone; Child; Histiocytic Necrotizing Lymphadenitis; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Lymph Nodes; Macular Edema; Male; Mediastinum; Meropenem; Radiography, Thoracic; Salmonella enteritidis; Salmonella Infections; Thyroiditis, Autoimmune; Tomography, X-Ray Computed; Treatment Outcome

To describe a case of hemophagocytic lymphohistiocytosis (HLH) with ocular changes prior to the systemic changes.. A 53-year-old man presented with the chief complaint of decreased vision in his right eye. The patient was examined by ocular examination, slit lamp examination, optical coherence tomography, laboratory examination, abdominal ultrasound, and bone marrow biopsy.. Ocular examination revealed uveitis OD and optical coherence tomography revealed macular edema OD. Laboratory examination demonstrated cytopenia in two cell lines, hypofibrinogenemia, and elevated serum ferritin. Abdominal ultrasound findings indicated hepatosplenomegaly. The bone marrow biopsy specimen demonstrated histiocytes and significant hemophagocytosis, leading to a diagnosis of HLH.. Ophthalmic manifestation can be the first sign of HLH and progress to fatal systemic changes.

Topics: Anti-Bacterial Agents; Biopsy; Bone Marrow; Drug Therapy, Combination; Fatal Outcome; Hepatomegaly; Humans; Immunoglobulins, Intravenous; Lymphohistiocytosis, Hemophagocytic; Macular Edema; Male; Meropenem; Methylprednisolone; Middle Aged; Panuveitis; Slit Lamp Microscopy; Splenomegaly; Thienamycins; Tomography, Optical Coherence