ro13-9904 and Papilledema

We report on the case of a young immunocompetent female patient with parainfectious optic neuritis and macular inflitrate due to Neisseria meningitidis B meningitis.. Case report RESULTS: A 22-year-old female patient was admitted to the emergency department for intensive care treatment with a strong suspicion of meningitis. Clinical and serological parameters were indicative of a bacterial genesis of the meningitis. By analysis of the cerebrospinal fluid (CSF) Neisseria meningitidis type B could be detected. Subjective and objective symptoms could be improved by immediate intravenous administration of antibiotics; however, 1 day before discharge the patient complained of a sudden left-sided, painful loss of vision with extreme photophobia. The ophthalmoscopic examination revealed profound ciliary injection with slight anterior uveitis and papilledema with macular infiltration and diffuse petechiae-like retinal hemorrhage. After exclusion of viral proliferation in the CSF systemic steroid therapy was carried out together with continuation of antibiotic therapy and the eye was treated with local steroids and mydriatics. This resulted in healing of the ocular inflammation and partial recovery of vision.. The painful loss of vision in this patient is probably due to parainfectious optic neuritis with macular infiltrate from Neisseria meningitidis B meningitis, which is an unusual course. Despite the rarity of this disease the complication of a parainfectious inflammation of the optic nerve should be considered and appropriate steps taken when the corresponding symptoms occur.

Topics: Acyclovir; Adrenal Cortex Hormones; Ceftriaxone; Female; Humans; Infusions, Intravenous; Macula Lutea; Meningitis, Meningococcal; Mydriatics; Neisseria meningitidis, Serogroup B; Ophthalmic Solutions; Ophthalmoscopy; Optic Neuritis; Papilledema; Retinal Diseases; Uveitis, Anterior; Young Adult

Topics: Administration, Oral; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Humans; Infusions, Intravenous; Male; Middle Aged; Optic Disk; Papilledema; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

A 53-year-old Japanese female developed a fever about two months after a tick bite. She also exhibited blurred vision, central scotoma in the left eye, left facial paresis and mild ataxia. A fundus examination revealed left disc swelling in the left eye. An ophthalmological examination showed decreased visual acuity with central scotoma in the left eye. We suspected neuroborreliosis because of the presence of pleocytosis and an elevated level of IL-6 in the cerebrospinal fluid (CSF), in addition to the characteristic neurological findings. She was positive for serum IgG antibodies against Borrelia by a Western blot of her serum. Therefore, we diagnosed her to have neuroborreliosis with papillitis. After the combined administration of antibiotics and steroids, her symptoms gradually improved, but not all of her eye manifestations resolved. Although ocular involvement is rare in neuroborreliosis, this case highlights the fact that neuroborreliosis shoud be considered as a differential diagnosis for patients presenting with papillitis. The diagnosis of neuroborreliosis is important since improvement of the visual acuity is possible with specific antibiotheraphy. In cases with papillitis of unknown etiology, it might be better to consider the possibility of neuroborreliosis should be considered when there are signs of Lyme borreliosis, such as facial nerve palsy, arthritis or radiculoneuritis.

Topics: Asian People; Biomarkers; Borrelia burgdorferi; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Female; Humans; Immunoglobulin G; Lyme Neuroborreliosis; Methylprednisolone; Middle Aged; Papilledema; Prednisolone; Pulse Therapy, Drug; Tick Bites; Treatment Outcome

Topics: Borrelia burgdorferi; Ceftriaxone; Cephalosporins; Child; Diagnosis, Differential; Female; Humans; Lyme Disease; Papilledema; Retinitis; Serologic Tests

A 22 year old female presented with sudden onset of uncrossed diplopia at distance, intracranial hypertension, esotropia and was evaluated. Microbiological tests of CSF and sera showed for brucellosis and the patient received therapy for this and her intracranial hypertension. The papilledema, headache, esotropia and diplopia all disappeared after therapy.. Diagnostic tests for brucella must be considered for patients who have divergence palsy and papilledema, especially those living in endemic areas.

Topics: Acetazolamide; Adult; Antibiotics, Antitubercular; Brucella melitensis; Brucellosis; Ceftriaxone; Central Nervous System Bacterial Infections; Cephalosporins; Cerebrospinal Fluid; Diplopia; Diuretics; Drug Therapy, Combination; Esotropia; Female; Humans; Intracranial Hypertension; Papilledema; Rifampin

Intraocular inflammations as chief manifestation of a T. pallidum infection associated with stage II syphilis are rarely documented in the recent literature. We report on a 35 year old patient with bilateral choroiditis, retinal vasculitis and papillitis persisting retrospectively since he had received some medication for syphilis 8 years previously. This patient was at high risk for other sexually transmitted diseases, however, he did not show HIV-seroconversion. General symptoms like uneasiness, fatigue, depressions and intermittent weight loss were mentioned. Reduction of visual acuity with topical corticosteroid therapy led to another medical work-up, and a systemic therapy with Ceftriaxone for 14 days resulted in better vision, better perimetric results and less inflammatory cell in the vitreous but evident optic atrophy.

Topics: Adult; Ceftriaxone; Chorioretinitis; Drug Therapy, Combination; Follow-Up Studies; Humans; Male; Methylprednisolone; Neurosyphilis; Papilledema; Retinal Detachment; Syphilis Serodiagnosis; Visual Acuity; Visual Fields