Charles Bonnet syndrome (CBS) is a disorder of visual hallucinations in psychologically normal patients with ocular disease or damage to visual pathways. The etiology of CBS is not fully understood. It is associated with various triggers, with age-related macular degeneration the most common; other triggers are systemic diseases such as stroke, multiple sclerosis, and anemia as well as lighting issues, fatigue, and medical or surgical eye treatments. Visual disturbances such as decreased visual acuity, visual field deficits, or visual hallucinations are common in association with hypertensive encephalopathy. We describe a patient with episodic CBS triggered by recurrent hypertensive crises, which resolved with blood pressure management in the hospital setting.
Background Infection is a major cause of morbidity and mortality in cancer patients. Gram-positive bacteria account for more than half of all documented bacterial infections in cancer patients, and streptococci are the most frequent pathogen among them. Rarely, group C, F, and G β-hemolytic streptococci have been shown to cause human disease. In this study, we describe the clinical characteristics and outcomes of these infections in cancer patients. Methods We performed a retrospective chart review of 157 patients who tested positive for group C, F, or G Streptococcus at the Moffitt Cancer Center between February 2012 and June 2018. Of those 157 patients, 79 were diagnosed as having a true Streptococcus infection. The study population was identified by positive cultures obtained from the microbiology laboratory during the same period. Results Of those 79 patients, 67 (85%) had solid tumor malignancies. The leading underlying diseases among these patients were gynecologic cancers (18%), head and neck squamous cell carcinoma (16%), and colorectal cancer (13%). Group G infections (23%) were significantly more common in patients with hematologic malignancies compared with group C or F streptococcal infections (4%). Other bacteria were isolated in 56 patients, the most common being Streptococcus species, Staphylococcus species including methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa. Seventy-two (92%) patients received antibiotics as soon as an infection was suspected, with the most common treatment regimen being a combination of vancomycin and a β-lactam antibiotic to treat polymicrobial infections. Conclusions Group C, F, and G streptococci are common pathogens in patients with an underlying malignancy, particularly solid tumor malignancies. Their usual association with other pathogens furthers the need for combinatorial therapeutic strategies to combat polymicrobial infections.
Patients with hematologic malignancy are immunocompromised either due to the underlying disease or from chemotherapy, resulting in an increased risk for opportunistic infections. Neutropenic patients with vancomycin-resistant Enterococci colonization are at risk of bacteremia with rare endogenous dissemination, which can result in hematogenous spread to the eye. We describe a patient with a hematologic malignancy with treatment-related neutropenia who developed endogenous vancomycin-resistant Enterococcus gallinarum endophthalmitis along with a review of the literature related to this case.
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