Conjunctival Inflammation and Amyloidosis in Allergic Granulomatosis and Angiitis (Churg-Strauss Syndrome)

Bilateral Subconjunctival Masses as a Rare Presentation of Churg-Strauss Syndrome

“…15 However, the nodular tarsal conjunctival lesions in this last case also showed amyloid deposits and were similar in appearance to that in other reported cases of conjunctival amyloidosis. 15 Yaman et al have previously reported on a patient with bilateral superior conjunctival involvement but this patient was already diagnosed with CSS and his ocular symptoms manifested 1 month after the cessation of antituberculosis therapy. 16 In 2001 Takanashi et al classified ocular manifestations into two groups: orbital inflammatory pseudotumor and ischemic vasculitis.…”

“…The remaining cases cited in the literature all had unilateral involvement [10][11][12][13][14][15] with either a single nodular elevation of the conjunctiva, [10][11][12] progressive thickening of the bulbar and palpebral conjunctiva, 13 or a nodular infiltration of the tarsal conjunctiva causing a fullness 14 and an irregular consistency of the upper eyelids. 15 However, the nodular tarsal conjunctival lesions in this last case also showed amyloid deposits and were similar in appearance to that in other reported cases of conjunctival amyloidosis. 15 Yaman et al have previously reported on a patient with bilateral superior conjunctival involvement but this patient was already diagnosed with CSS and his ocular symptoms manifested 1 month after the cessation of antituberculosis therapy.…”

Conjunctival Involvement in Lymphomatoid Granulomatosis

“…A combination of the pathologic findings in these successively involved organs clearly indicates progression of disease severity: in filtration of relatively benign mature lympho cytes, plasma cells and atypical lymphoid cells of the skin, more malignant mixed lym phoid cells and some large lymphoreticular cells of the lung and a preponderance of large blastic-formed lymphoid cells of the conjunc tiva, the most malignant findings for the patient. As stated in a preceding paragraph, it is considered a characteristic of lymphoma toid granulomatosis that the cytologic com position of the lesions shifts with progressing severity at different areas and different times [6], Similarly, conjunctival involvement has also been reported in Churg-Strauss syn drome [ 10,11 ]. Both the lymphomatoid gran ulomatosis and Churg-Strauss syndrome present with an idiopathic granulomatous inflammation involving pulmonary vascula ture and that of several other organ systems but the latter has a unique occurrence of asth ma and granulomatous inflammation with eosinophils [7], In one report [10], a 32-yearold woman had a superior conjunctival no dule which very much mimicked the lesion in our case.…”

“…As stated in a preceding paragraph, it is considered a characteristic of lymphoma toid granulomatosis that the cytologic com position of the lesions shifts with progressing severity at different areas and different times [6], Similarly, conjunctival involvement has also been reported in Churg-Strauss syn drome [ 10,11 ]. Both the lymphomatoid gran ulomatosis and Churg-Strauss syndrome present with an idiopathic granulomatous inflammation involving pulmonary vascula ture and that of several other organ systems but the latter has a unique occurrence of asth ma and granulomatous inflammation with eosinophils [7], In one report [10], a 32-yearold woman had a superior conjunctival no dule which very much mimicked the lesion in our case. In the other report [11], conjuncti val biopsy revealed diagnostic findings of the Churg-Strauss syndrome.…”

Recurrent subconjunctival and periorbital haemorrhage as the first presentation of systemic AL amyloidosis secondary to myeloma

“…Clinically conjunctival amyloidosis usually presents as a painless palpable mass 1 and occurs most commonly after inflammatory conditions such as trachoma, 2 or more rarely with chronic recurring uveitis, 3 rheumatoid arthritis, 4 and Churg-Strauss syndrome. 5 Systemic forms of amyloidosis usually spare the conjunctiva. 6 Even with monoclonal gammopathies and multiple myeloma where systemic amyloidosis is common, conjunctival amyloidosis is rare.…”