Background Acute retinal necrosis is considered a rare infectious uveitis. This condition is usually caused by varicella-zoster virus or herpes simplex virus. Acute retinal necrosis caused by co-infection with multiple viruses is extremely rare. Herein, we report a case of acute retinal necrosis caused by co-infection with herpes simplex virus (type I and II) and varicella-zoster virus (VZV) in a natalizumab-treated patient due to multiple sclerosis. Case presentation An adult man presented with a complaint of decreased vision of the right eye from 12 days ago. He was a known case of multiple sclerosis receiving natalizumab. Examination of the right eye revealed severe conjunctival injection, fine diffuse keratic precipitates, 3 + anterior chamber and vitreous cells, elevated intraocular pressure (26 mmHg), a blurred optic disk with hemorrhagic patches, and occlusive vasculitis plus confluent necrotizing patches in the peripheral retina compatible with diagnosis of acute retinal necrosis. He underwent anterior chamber and vitreous tap, and real-time PCR detected HSV I & II and VZV on the vitreous specimen. A second PCR showed the same result. After neurological consultation, natalizumab was discontinued and intravenous acyclovir was started followed by oral acyclovir and oral prednisolone to control the disease, which was successful. Conclusions Although rare, multiple-viral infection should be considered in the physiopathology of acute retinal necrosis, especially in immunosuppressed patients.
Background Anti-vascular endothelial growth factor (Anti-VEGF) therapy is now considered as one of standard therapies in approaching infants with retinopathy of prematurity (ROP). The purpose of this study was to assess the time to full retinal vascularization in infants with ROP who were treated with intravitreal bevacizumab (IVB). Methods This retrospective cohort study evaluated premature infants with ROP who were treated with IVB between 2012 and 2019. Demographic and clinical data were collected from the medical records and analyzed. Main outcomes were defined as time to complete vascularization and time of zone shift. Results Eight hundred sixty-five eyes from 441 patients were included. Average gestational age and birth weight were 28 ± 4 weeks and 1121 ± 624 g, respectively. Primary treatment failure and reactivation occurred in 35 eyes (4.0%) and 33 eyes (3.8%), respectively. Recurrent ROP occurred significantly more frequently in infants with pre-treatment zone 1 ROP compared to those with zone 2 ROP (7.6% versus 3%, p < 0.01). Patients with pre-treatment zone 2 reached zone 3 faster than those with pre-treatment zone 1 (142 ± 152 days versus 181 ± 174 days, p < 0.01); however, the time until full retinal vascularization did not significantly differ between the groups (p = 0.10). Conclusion This study revealed that pre-treatment ROP zone was associated with ROP reactivation rate but not with time to full vascularization in those treated with IVB. Trial registration Retrospectively registered; IR.TUMS.FARABI.REC.1399.040
Background: Recent evidence suggests a connection between celiac disease and dilated cardiomyopathy. Herein, we serologically screened for celiac in dilated cardiomyopathy patients and investigated its correlation with ejection fraction. Methods: We selected 123 cardiomyopathy patients. Patients were screened for celiac, using anti-tissue transglutaminase (ATA), anti-gliadin (AGA), and anti-endomysial (EMA) immunoglobulin type A (IgA) antibodies. Total IgA levels were also measured. Results: Of 123 patients, 3 were EMA positive (2.4%), 4 were AGA positive (3.3%) and 5 were ATA positive (4.1%). EMA positive patients had significantly lower EF values compared to EMA negative patients (35±5 vs. 46.52±9.21, p-value: 0.034). Similar results were observed for AGA (32.5±14.34 vs. 46.7±8.8, p-value: 0.002), but not for either ATA positivity (40±10 vs. 46.5±9.21, p-value: 0.126) or IgA deficiency (50±5 vs. 46.14±9.37, p-value: 0.480). No significant difference was observed in the age and gender of seropositive patients compared to seronegative. Conclusion: We observed a higher prevalence of celiac seropositivity among dilated cardiomyopathy patients compared to the general population. EMA and AGA positive patients had significantly lower ejection fractions compared to their negative counterparts.
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