case presentation 2010 fois meeting - uveitis · manisha mehta, md luis alonso gonzalez-gonzalez,...

21

CASE PRESENTATION Sana S. Siddique¹´², C. Stephen Foster ¹´² 1 Massachusetts Eye Research and Surgery Institution (MERSI), Cambridge, MA 2 Ocular Immunology and Uveitis Foundation

Upload: others

Post on 23-Jun-2020

1 views

Category:

Documents

0 download

Report

Download

Embed Size (px):

TRANSCRIPT

Page 1: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

CASE PRESENTATION

Sana S. Siddique¹´², C. Stephen Foster ¹´²1Massachusetts Eye Research and Surgery Institution (MERSI), Cambridge, MA2 Ocular Immunology and Uveitis Foundation

Page 2: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

History of Presenting Illness

54 year old Caucasian female with recurrent unilateral redness and irritation OS

4-5 episodes over 4 years treated with Tobradex

No workup, systemic treatment, or IMT specifically for ocular symptoms

1 month of redness and irritation prior to initial presentation at MERSI

Page 3: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Past Medical History

Cutaneous pemphigus vulgarisDiagnosed by skin biopsy in 2004Extensive esophageal involvement initiallyNumerous treatments: multiple courses of oral Prednisone CellCept, Rituxan and IV-Ig (since 2005)

Currently in remission on Rituxan and IV-Ig

DepressionParoxetine

Recurrent genital herpesSystemic Acyclovir

Page 4: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Initial Examination

VA sc 20/20 OD, 20/25 OS

Pupils 4>2 OU, no RAPD

CVF full OU

EOM full OU

IOP 20mmHg OU

Page 5: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Page 6: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Exam OD OS

Lids WNL WNL

Conjunctiva/Sclera White & quiet Diffuse 1+ injection with 3+ superficial& deep vessel injection superiorly witha central white opacity

Cornea Clear Clear

Anterior Chamber Deep and quiet Deep and quiet

Iris Round and reactive

Round and reactive

Lens PSC PSC

Page 7: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

PLAN??Serologies

Conjunctival & Scleral biopsy for Immunohistochemical staining

Page 8: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Laboratory Studies

HLA typing

ACE

Lysozyme

ESR, CRP

C3, C4, CH50,

RF

Properdin factor 3

Bartonella henselae & quintana IgG/IgM

Hepatitis B

ANCA

Antibody testing: SSA

SSB

SS-DNA

DS-DNA

Smith

Page 9: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Laboratory Studies

IgE : 298 (<114 normal)

ANA : positive Titer 1:160

Pattern homogenous

C1Q complexes: 8.1 (<4.4 normal)

C3D complexes: 18 (<8 normal)

Page 10: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Intraoperative Findings

Page 11: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Conjunctival Biopsy: H&E

Page 12: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Conjunctival Biopsy: PAS

Page 13: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Direct IF staining of conjunctival biopsy with IgG

Page 14: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Conjunctival Biopsy: Direct IF

Page 15: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Direct IF staining of conjunctival biopsy with anti-HSV IgG

Page 16: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Conjunctival Biopsy – HSV IgG

Page 17: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Direct IF staining of conjunctival biopsy with anti-VZV antibody (negative control)

Page 18: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Page 19: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Diagnosis??

Ocular Pemphigus Vulgaris complicated by HSV

Page 20: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Treatment

Acyclovir was replaced with Valacyclovir

Ocular inflammation has been quiet for the past 10 months while on therapy with IV-Ig infusions and valacyclovir, without topical steroids

Page 21: Case Presentation 2010 FOIS Meeting - Uveitis · Manisha Mehta, MD Luis Alonso Gonzalez-Gonzalez, MD Thank You. Title: Case Presentation 2010 FOIS Meeting Author: sana Created Date:

Acknowledgements

C.Stephen Foster, MD, FACS, FACR

Quan Nguyen, MD

Mark Dacey, MD

Manisha Mehta, MD

Luis Alonso Gonzalez-Gonzalez, MD

Thank You

Emory Department of Anesthesiology...Torres, MD Christopher Weeden, MD CA2 Residents Sunil Agarwal, MD Estela Chen Gonzalez, MD Matt Cucino, MD Melat Gebre, MD Mary Katherine Hampy,

FELIPE GONZALEZ GONZALEZ, Gobernador Constitucional del

Relación Definitiva de Admitidos y Excluidos-10 · GONZALEZ FORCADA, RAQUEL GONZALEZ GARCES, EDURNE GONZALEZ GARCIA, CRISTINA GONZALEZ GIMENEZ, MONICA PILAR GONZALEZ JURADO, RUBEN

Lizmarie Gonzalez -Vega MD

VIGENCIA 2012 CESAR EDUARDO GONZALEZ DIAZ. MD-GERENTE

APECE-505 Intelligent System Engineering Basics of Digital Image Processing! Md. Atiqur Rahman Ahad Reference books: – Digital Image Processing, Gonzalez

EL FARMACÉUTICO PILAR IMPRESCINDIBLE EN EL CUIDADO DEL ... · PRINCIPALES EFECTOS SECUNDARIOS ... Maritza A. Middelkamp-Hup MD Salvador,Gonzalez,MD,PhD, et al. Oral Polypodium leucotomos

C224e Recursos Humanos-20180406113634 de Empleo... · desiree iraida loreley . gonzalez gonzalez gonzalez gonzalez gonzalez gonzalez gonzalez gonzalez gonzalez ... negrin morales

cdigital.dgb.uanl.mxcdigital.dgb.uanl.mx/la/1020081511/1020081511_051.pdf · 2011-03-31 · mario antonio gonzalez gonzalez espino gonzalez oliverto gonzalez garcia sanchez esparza

Delivering care to the underserved: Increasing the Numbers of Minority Physicians Ruben Gonzalez MD CCRMC

Pathology of Chronic Viral Hepatitis: Nomenclature Grade & Stage Carmen Gonzalez Keelan MD FCAP FASCP Consultant, UPR School of Medicine

Viseaza, lupta, invinge - Gabriela Gonzalez, Ruben Gonzalez lupta, invinge - Gabriela Gonzalez...Viseaza, lupta, invinge - Gabriela Gonzalez, Ruben Gonzalez Created Date: 6/20/2019

Clinical Overview of Age-Related Macular Degeneration Victor H. Gonzalez, MD Medical Director Valley Retina Institute McAllen, TX

Ruth liliana gonzalez gonzalez dn13 (3)

Gonzalez-The Role of Surgery for Stage IV Cancer Surgery and the Role of Surgery for Stage IV Cancer Ricardo J. Gonzalez, MD Assistant Professor of Surgery University of Colorado Objectives

· gonzalez agÜero, jose javier gonzalez delgado, oscar gonzalez garcia, eduardo gonzalez gomez, adrian gonzalez gonzalez, raul gonzalez navarro, david gonzalez sanz, maria concepcion

FELLOWS - AAGL€¦ · j. ia nijjar, md, mph, msed aylor ollege of mediine houston, texas luis mar elo garza-ayala, md luis fernando garia rodriguez, md raul leal gonzalez, md tenolÓgio

BüE MINISTERIO Tecnologtas de la InformaclOn, GestlOn ... · apellidos y nombre gonzalez gonzalez, luis-gonzalez morado, enrique gonzalez conde lopez, enrique ramón gonzalez-haba

DXD1314 2Q 2B GONZALEZ GONZALEZ CRISTIAN

2019 JPIP-A 病理診断生涯教育プログラムLeslie Dodd, MD FCAP Sabrina C. Sopha, MD FCAP Raul Gonzalez, MD FCAP Nichole L. Steidler, MD FCAP Christina Isacson, MD FCAP Justin

FINTECH - Les Echos Events · ple moyen sur chiffre d’affaires de 17 fois le CA !» De quoi rendre perplexes certains ... Fintech investment Advisory vs Acteurs ... Nicolas Gonzalez

ceoboecillo.centros.educa.jcyl.esceoboecillo.centros.educa.jcyl.es/sitio/upload/escanear0097_1.pdf · GONZALEZ GONZALEZ OSCAR LORENZO GONZALEZ GONZALEZ OSCAR LORENZO DE FRUTOS TENA

ARTISTICA DOCENTE: MARIA ESNITH GONZALEZ GONZALEZ …

Sulodexide in the treatment of patients with early stages of ......2020/12/04 · Alejandro J. Gonzalez-Ochoa MD 1,2, Joseph D. Raffetto MD 3; Ana G. Hernández MD 4, Nestor Zavala

Monica Serrano-Gonzalez, MD PGY-5, Year 2 Pediatric ...c.ymcdn.com/sites/ Serrano-Gonzalez, MD PGY-5, Year 2 Pediatric Endocrinology Fellow Children’s Hospital Los Angeles Center

Télécharger « CE2 - Mathématiques P2.pdfekladata.com/gzPT3Vr9LEIwOJq7qVPhsfthXgw/CE2-Mathematiques-P2.pdf · 4 fois 1 = 4 4 fois 2 = 8 4 fois 3 = 12 4 fois 4 = 16 4 fois 5 = 20

Ruth liliana gonzalez gonzalez 1

Ruth liliana gonzalez gonzalez dn13

Spontaneous Fungal PeritonitisSpontaneous Fungal Peritonitis A Rare Complication of Heart Failure Ariel F. Gonzalez-Cordero, MD, Melanie Malavé-Sánchez, MD, Mark Vergara-Gómez,

Copyright 2006, Francisco Javier Gonzalez Gonzalez

YOU’RE INVITED Reunion... · 2018-04-02 · Cyndi Yag-Howard, MD ’93 Ricardo Gonzalez MD ’97 Mylissa Graber MD ’97 Richard Layfield MD ’97 Ryan Secan MD ’97 Pinkal Patel

Gonzalez - SEP Monitoring (S) Part I/Gonzalez - SEP Monitoring (S).pdfAndres A Gonzalez, MD Director, Surgical Neurophysiology Keck Medical Center of USC University of Southern California

Revista-karen Gonzalez Gonzalez

Humanismo, Gonzalez Gonzalez

RCC Vol. 6 No. 1 - revcolcard.org · jorge leon galindo, md co-editores hernando del portillo carrasco, md hector gonzalez recaman, md ... maria eugenia calderon barraza