Tinea capitis is a superficial fungal infection of the scalp and hair caused by dermatophytes such as Trichophyton and Microsporum. Tinea capitis is very rare in adults, and may affect those with immunosuppressive diseases or menopausal elderly women. Clinical manifestations along with trichoscopy and Wood's light, can help the clinician to determine the correct diagnosis, in order to reduce irreversible sequelae and decrease multiple contagion. KOH direct exam and culture confirm diagnosis and aetiology. We report a 61-year-old female with a 50-year history of tinea capitis. This is an atypical case in a postmenopausal elderly woman who was treated as seborrheic dermatitis.
A 54-year-old white woman presented with a complaint of 4 days of painless loss of vision in the right eye. She has a medical history of high cholesterol and depression. Current medications include atorvastatin, paroxetine, calcium, vitamin D, and a multivitamin. The patient has a history of having oral cold sores approximately once a year. She does not have any genital ulcers. She also has had chickenpox, measles, and mumps. Her surgical history is significant only for bladder surgery for urinary problems after the delivery of her children. She works as a real estate agent and stated that recently she had been showing old homes that were under foreclosure and had moldy environments. She lives in Maryland but has spent time living in Iran, Turkey, and Switzerland. She has two dogs and owned a cat several years ago. She reports smoking one pack of cigarettes a day. The family history is noncontributory. A detailed review of systems is significant for a few white patches of skin on her forearms, easy bruising, sinus trouble, and shortness of breath at times.On examination, the visual acuity with correction was count fingers at 3 feet without improvement on pinhole in the right eye and 20/32 with improvement on pinhole to 20/25 in the left eye. Slit-lamp examination of the anterior segment was significant for 2ϩ conjunctival injection in the right eye and 1ϩ injection in the left eye. The right cornea had fine keratic precipitates, and the left cornea was clear. The right anterior chamber had 3ϩ cells and flare; the left anterior chamber had no cell but 1ϩ flare. The right iris had posterior synechiae inferonasally. There was 1ϩ nuclear sclerosis of the lens in each eye. Intraocular pressures measured 16 mmHg in the right eye and 14 mmHg in the left eye.Dilated funduscopic examination of the right eye showed a hazy view with multiple white, fluffy balls throughout the vitreous cavity (Figure 1, A and B). There was a limited view of the optic nerve, which was edematous. There were yellow chorioretinal lesions in the macula and throughout the peripheral retina. There were also intraretinal hemorrhages throughout the periphery. The yellow lesions and hemorrhages were predominantly involving the inferior half of the midperipheral retina. The left eye also had a few white, fluffy balls in the vitreous and an optic disk with mildly blurry margins. The macula was without edema or lesions ( Figure 1C). There were sclerotic vessels extending off of the superotemporal and inferotemporal arcades ( Figure 1D). The midperiphery was notable for intraretinal hemorrhages. Fluorescein angiography transiting the left eye showed evidence of vasculitis and disk leakage ( Figure 1E). Questions1. What is your differential diagnosis? In particular, how does the presence of the fluffy balls in the vitreous cavity and the medical history affect the differential diagnosis? 2. What are the most important laboratory or imaging investigations that you would like to initiate? 3. If diagnostic vitrectomy is nondiagnostic, then would you consider...
A 17-year-old man, originally from Sierra Leone, presented to the Wilmer Eye Institute with blurry vision in his right eye and occasional achy pain in and behind the eye. He had visited his primary care physicians several weeks ago with similar symptoms where he was diagnosed with conjunctivitis and offered topical antibiotics. He did not respond to the treatment and was referred for further evaluation. The patient is generally healthy, but does have a history of hepatitis B after a blood transfusion in his native country many years ago during surgery for an abdominal trauma. Other surgical history is significant for hernia repair.The patient's social history includes living with his adopted mother, biologic father, and adopted grandmother for approximately 10 years, before which he lived in the aforementioned African nation. He has both a dog and cat at home. He has been working with his father on his farm for the past few months in West Virginia, but reports no major accidents or illnesses contracted. He admits to smoking marijuana once or twice weekly for 1 year, but no other recreational drug use. He is sexually active and uses protection most of the time. Family history is not known on his biologic mother's side, but negative on his father's side for any chronic illnesses or genetic conditions. Careful review of systems is noncontributory. Medical records from Sierra Leone indicated that the patient did receive vaccination for mumps, measles, and rubella, among others, but did not receive Bacille-Calmette-Guérin vaccination for tuberculosis.On presentation to our clinic, the visual acuity without correction was 20/50, pinhole to 20/25 in the right eye, and 20/15 in the left eye. Intraocular pressure was 13 in each eye. Slit-lamp examination revealed mild conjunctival injection and diffuse mutton-fat precipitates in the anterior chamber with 2ϩ cells and flare in the right eye. There was no pupillary synechiae. Slit-lamp examination of the left eye revealed no abnormality. Funduscopic examination of the right eye showed 1ϩ suspended cells in the anterior vitreous; there was no disk edema ( Figure 1A). Throughout the peripheral retina, there were vitreous clumps as well as sheathing of blood vessels. In the superotemporal quadrant, a well-demarcated, elevated, creamy-white chorioretinal lesion ( Figure 1B) was noted. There was a layer of cells overlying the lesion. No peripheral exudates were seen. Funduscopy of the left eye revealed no vitreous cells or other vitreo-retinal pathology.Imaging studies included red-free fundus photography ( Figure 1C), fluorescein angiography, and optical coherence tomography. Fluorescein angiography of the right eye demonstrated hyperfluorescence with late leakage of the superior and inferior vessels; the chorioretinal lesion was hypofluorescent with a border of hyperfluorescence and an area of nonperfusion immediately surrounding it (Figures 1, D-F). Fluorescein angiography of the left eye demonstrated normal vasculature. Optical coherence tomography demonstrated absence of m...
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