PurposeOcular manifestations in snake-bite injuries are quite rare. However, the unusual presentations, diagnosis and their management can pose challenges when they present to the ophthalmologist. Early detection of these treatable conditions can prevent visual loss in these patients who are systemically unstable and are unaware of their ocular condition. To address this, a study was conducted with the aim of identifying the various ocular manifestations of snake bite in a tertiary care center.MethodsThis is a one-year institute-based prospective study report of 12 snake bite victims admitted to a tertiary hospital with ocular manifestations between June 2013 to June 2014, which provides data about the demographic characteristics, clinical profiles, ocular manifestations, and their outcomes.ResultsTwelve cases of snake bite with ocular manifestations were included of which six were viper bites, three were cobra bites and three were unknown bites. Six patients presented with bilateral acute angle closure glaucoma (50%), two patients had anterior uveitis (16.6%) of which one patient had concomitant optic neuritis. One patient had exudative retinal detachment (8.3%), one patient had thrombocytopenia with subconjunctival hemorrhage (8.3%) and two patients had external ophthalmoplegia (16.6%).ConclusionsBilateral angle closure glaucoma was the most common ocular manifestation followed by anterior uveitis and external ophthalmoplegia. Snake bite can result in significant ocular morbidity in a majority of patients but spontaneous recovery with anti-snake venom, steroids and conservative management results in good visual prognosis.
SUMMARY Intestinal involvement in Schistosoma mansoni infection is usually confined to the ileum and colon. Duodenal infestation was diagnosed in a patient with recurrent schistosomiasis despite treatment who presented with a postoperative small bowel fistula. Duodenal schistosomiasis can be suspected on endoscopy, but must always be confirmed by biopsy.After penetrating the skin all schistosome species migrate to the portal system, where for unknown reasons, they distribute to different sites. Thus S jajponicum frequently is found in the superior mesenteric vein, S manasoni in the inferior mesenteric vein and S haematobiluml in the vesical plexus.Accordingly, S japonicum tends to involve the small intestine, descending colon and rectum; S mansoni the colon and lower ileum and S hacinatobilum the bladder, pelvic organs, and rectum.Duodenal involvement in S matnsoni infection has been reported only once before in the English literature.Case report A 37 year old man was admitted for the first time to our hospital for a persistent fistula close to the umbilicus. He was a resident of Northern Yemen and had never travelled outside the region. Ten years before he had been treated for schistosomiasis after a positive stool examination. Three years before admission he underwent emergency surgery in a local hospital for acute intestinal obstruction and was told that he had schistosomiasis for which medication was given. Postoperatively an intestinal fistula developed and he was reoperated without success. Since then the fistula has persisted, and he also has been
A 50-year-old female patient presented with protrusion of the left eye for 1 month. Examination showed abaxial proptosis, restriction of extraocular movements, and elevated intraocular pressure. Computed tomography of the orbits showed soft tissue enhancing lesion in the superolateral aspect of the left orbit with lytic lesions in calvarium. Fine needle aspiration cytology of the lesion revealed a diagnosis of plasmacytoma with positive CD138 and CD38 immunohistochemical stains. Erythrocyte sedimentation rate, C-reactive protein and serum lactate dehydrogenase were elevated. Serum protein electrophoresis revealed hypergammaglobulinemia, and bone marrow biopsy revealed 6% plasma cells. The patient was started on chemotherapy with bortezomib, dexamethasone and lenalidomide by the medical oncologist. Significant improvement in proptosis and extraocular movements noted on follow-up. Orbital myeloma may be the first manifestation of systemic disease.
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