ro13-9904 and Blindness

Children with conversion disorder experience neurological symptoms without a definable organic cause. Clinical presentation of conversion disorders is uncommon in the emergency department (ED).. An 11-year-old previously healthy girl presented to the ED for management of lobar pneumonia. She developed acute visual loss subsequent to accidental placement of an intra-arterial cannula in her arm. Clinical assessments by the emergency physician, neurology, ophthalmology, and psychiatry services, and negative neuroimaging studies established the diagnosis of functional visual loss as a manifestation of conversion disorder. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Conversion disorder symptoms are often without any specific markers and do not fit standard clinical guidelines. A comprehensive and step-wise evaluation of unusual clinical presentation by multiple specialties and ancillary test results should be considered to rule out organic causes and establish the diagnosis of conversion disorder, as seen in our patient.

Topics: Anti-Bacterial Agents; Blindness; Ceftriaxone; Child; Conversion Disorder; Emergency Service, Hospital; Female; Humans; Pneumonia

A 67-year-old man was transported to our hospital and diagnosed with pneumococcal meningitis. We immediately administered ceftriaxone and vancomycin according to the guidelines, but did not administer dexamethasone to him because he had been previously administered antibiotics. His left eye became complicated by endogenous endophthalmitis on the next day, which resulted in blindness, although his meningitis rapidly ameliorated. In comparison to other patients who have been reported to recover from complications with endophthalmitis after the combination therapy of antibiotics, corticosteroids and vitreous surgery, we consider that this patient's poor visual outcome may have been caused by severe inflammation or the breakdown of the blood ocular barrier due to the action of S. pneumoniae. Corticosteroids may be able to successfully treat such inflammation or disruption of the blood ocular barrier.

Topics: Aged; Anti-Bacterial Agents; Blindness; Blood-Retinal Barrier; Ceftriaxone; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Humans; Male; Meningitis, Pneumococcal; Streptococcus pneumoniae; Vancomycin

Topics: Anti-Infective Agents; Aortic Valve; Aortic Valve Insufficiency; Aza Compounds; Blindness; Ceftriaxone; Cough; Echocardiography, Transesophageal; Endophthalmitis; Fever; Fluoroquinolones; Hearing Loss, Sensorineural; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Moxifloxacin; Pneumococcal Infections; Quinolines; Streptococcus pneumoniae; Vancomycin; Vision Disorders

We report the case of an elderly woman presenting with group G streptococcal septicaemia associated with osteomyelitis and endophthalmitis.

Topics: Administration, Topical; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Blindness; Ceftriaxone; Chloramphenicol; Clindamycin; Dexamethasone; Endophthalmitis; Eye Enucleation; Female; Humans; Injections, Intravenous; Metatarsal Bones; Ofloxacin; Osteomyelitis; Streptococcal Infections; Streptococcus; Treatment Outcome

The bilateral simultaneous optic neuritis is rarely associated with multiple sclerosis. Diagnosis and prognosis have to be dealt with independently.. A 45-year-old woman presented with an acute bilateral simultaneous amaurosis which developed within one day with bilateral papilledema. Initially there were positive antinuclear and anticytoplasmatic antibodies and antibodies against heart and skeletal muscles. The serum titer was elevated for immunoglobulin A, lowered for complement factors C3 and C4. Antigens for polio-virus type 3 and coxsackievirus type B5 and B3 were borderline positive. An oncologic, toxic or vascular cause of the neuritis was unlikely.. The amaurosis lasted for 4 days. Vision improved gradually under a combined therapy with steroids, antibiotics and virostatics. Nineteen months later the vision was 20/25 OD and 20/200 OS.. The acute bilateral neuritis was probably of autoimmunological origin. Under combined antiinfectious and steroidal therapy vision improved more than expected.

Topics: Acyclovir; Autoantibodies; Autoimmune Diseases; Blindness; Cardiolipins; Ceftriaxone; Complement C3; Complement C4; Diagnosis, Differential; Drug Therapy, Combination; Female; Fluorescein Angiography; Humans; Immunoglobulin A; Methylprednisolone; Middle Aged; Optic Neuritis; Visual Acuity; Visual Fields