trimethoprim--sulfamethoxazole-drug-combination and Scleritis

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Retrospective Studies; Scleritis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Administration, Oral; Administration, Topical; Aged; Anti-Bacterial Agents; Aza Compounds; Drug Resistance, Bacterial; Drug Therapy, Combination; Eye Infections, Bacterial; Female; Fluoroquinolones; Gatifloxacin; Humans; Keratitis; Microbial Sensitivity Tests; Moxifloxacin; Nocardia; Nocardia Infections; Quinolines; Scleritis; Trimethoprim, Sulfamethoxazole Drug Combination

To report a case of necrotizing nocardial scleritis treated with surgical debridement and topical polyvinyl alcohol iodine (PAI) and antibiotics.. A 78-year-old man underwent phacoemulsification with intraocular lens implantation in the left eye. He had an uncomplicated postoperative course for 2 months but then developed infectious scleritis. The patient received intensive antibiotics treatments; however, the lesion did not respond. Because of the poor response, Nocardia infection was suspected, and the lesion was repeatedly scraped and the patient was treated with systemic trimethoprim/sulfamethoxazole (TMP-SMX, 800 mg/day) and topical PAI (0.033%, 4 times/day). Cultures of the scrapings grew Nocardia. The treatment led to a complete resolution of the infection.. Necrotizing nocardial scleritis can be treated by surgical debridement and systemic TMP-SMX and topical PAI.

Topics: Aged; Anti-Bacterial Agents; Combined Modality Therapy; Debridement; Humans; Iodine; Male; Nocardia Infections; Polyvinyl Alcohol; Scleritis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Anterior scleritis is defined as an inflammation of the sclera, located anteriorly to the equator of the eye. Cotrimoxazole is an antibiotic with an immunomodulatory action.. In case of idiopathic anterior scleritis or scleritis associated with autoimmune diseases, immunosuppressive treatment is often required. We report on six patients with anterior idiopathic scleritis non sensitive to local treatment where cotrimoxazole improved or cured the symptoms.. Cotrimoxazole seems to be an interesting therapeutic treatment in non threatening anterior scleritis.

Topics: Aged; Anti-Infective Agents; Antibodies, Antineutrophil Cytoplasmic; Antibodies, Antinuclear; Autoimmune Diseases; Female; Humans; Immunologic Factors; Middle Aged; Recurrence; Scleritis; Trimethoprim, Sulfamethoxazole Drug Combination

To report a case of sclerokeratitis caused by Nocardia asteroides in a soft contact lens wearer.. A 65-year-old male presented with a 2-month history of a corneal ulcer in the left eye. He wore two weekly disposable soft contact lenses on an extended basis. He revealed his history of gardening before the onset of symptoms. On examination, his best-corrected visual acuity was 20/30 in the right eye and 20/400 in the left eye. In the left eye, there was conjunctival injection. His cornea showed multiple patchy infiltrates, with a feathery border that was raised and involved up to the midstroma. There was a 3+ anterior chamber reaction. Corneal scrapings were performed for smears and cultures. Topical 2% amikacin sulfate every half hour along with oral clarithromycin therapy was initiated. On follow-up, the sclera lesions worsened.. Smears of corneal scrapings revealed gram-positive filamentous bacteria in Gram's stain. The cultures grew Nocardia asteroides. The patient was switched to trimethoprim-sulfamethoxazole (Bactrim DS, Roche Laboratories, Nutley, NJ) as the sclera was involved. The patient responded to treatment, and the infection resolved. When last seen, approximately 4 months after his initial presentation to us, his visual acuity was 20/40 in the affected eye. There was corneal scarring, and the adjacent sclera showed thinning.. Nocardia sclerokeratitis can be associated with contact lens wear. Nocardia should be considered in the differential diagnosis of a corneal ulcer with an indolent progressive course with feathery infiltrates. Topical amikacin and systemic trimethoprim-sulfamethoxazole are effective drugs in the treatment of nocardial corneal infection with scleral involvement.

Topics: Aged; Anti-Bacterial Agents; Contact Lenses, Extended-Wear; Humans; Keratitis; Male; Nocardia asteroides; Nocardia Infections; Scleritis; Trimethoprim, Sulfamethoxazole Drug Combination

Ophthalmic involvement may be noted in < or = 58% of Wegener's granulomatosis cases, scleritis being one of the most frequent and potentially devastating manifestations. Cytotoxic immunosuppressive drug therapy is effective treatment for this disorder but potentially highly toxic. Recent uncontrolled and anecdotal reports have suggested a possible therapeutic role for a much less toxic agent, trimethoprim/sulfamethoxazole, in limited Wegener's granulomatosis. We report a patient who had a conjunctival nodule and scleritis. Biopsy of the nodule suggested Wegener's granulomatosis, confirmed serologically with serum anti-neutrophil cytoplasmic antibody (ANCA) testing. Treatment with oral trimethoprim/sulfamethoxazole was successful. Clinical response was paralleled by normalization of serial anti-neutrophil cytoplasmic antibody titers. This case is the first well-documented ophthalmologic report of limited Wegener's granulomatosis responding to trimethoprim/sulfamethoxazole and adds to the body of literature suggesting a potential role for this drug in selected cases of limited Wegener's granulomatosis.

Topics: Administration, Oral; Antibodies, Antineutrophil Cytoplasmic; Autoantibodies; Biomarkers; Conjunctival Diseases; Female; Granulomatosis with Polyangiitis; Humans; Immunoglobulin G; Middle Aged; Scleritis; Trimethoprim, Sulfamethoxazole Drug Combination