Diffuse Bilateral Subacute Neuroretinitis

Souza, Eduardo Cunha de; Abujamra, Suel; Nakashima, Yoshitaka; Gass, J. Donald M.

doi:10.1001/archopht.117.10.1349

Cited by 67 publications

(12 citation statements)

References 8 publications

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“…3 , 16 , 17 DUSN is usually unilateral, though a few bilateral cases have been reported in literature. 2 , 11 , 18 In the current study, all patients had unilateral presentation. Majority (69.42%) of the patients in a retrospective case series of 121 Brazilian patients with DUSN 12 were younger than 20 years, which is similar to the number of young patients in this case series (76.92% – age 20 or less).…”

Section: Discussionmentioning

confidence: 64%

Clinical experience in treatment of diffuse unilateral subretinal neuroretinitis

Relhan

Pathengay

Raval

et al. 2015

OPTH

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PurposeTo describe the clinical features, management, and outcomes of patients with diffuse unilateral subacute neuroretinitis (DUSN).MethodsA noncomparative, consecutive analysis of case series from two tertiary care campuses of LV Prasad Eye Institute, India, between January 2011 and April 2014 was performed. Medical records of the patients presenting with DUSN (early or late stage) were reviewed.ResultsThe current study included 13 patients. The majority (10/13, 76.92%) of the patients were aged 20 years or less. All patients had unilateral eye involvement. Visual acuity at presentation was 20/200 or worse in 9/13 (69.23%) patients. A delay in diagnosis occurred in 6/13 patients, and initial diagnosis in these patients included retinitis pigmentosa (4 patients) and posterior uveitis (2 patients). Clinical features included early presentation (prominent vitritis, localized retinitis, and vasculitis) in 7/13 (53.85%) patients and late presentation (attenuation of vessels, retinal pigment epithelium atrophic changes, and optic atrophy) in 6/13 (46.15%) patients. Worm could not be identified in any of the cases. All the patients received laser photocoagulation of retina and oral albendazole treatment for a period of 30 days. With treatment, visual acuity improved in seven patients (six early stage, one late stage) and remained unchanged in six patients. Mean follow-up period was 8.69 months (range, 1–21 months). The mean central foveal thickness in the affected eye, done by optical coherence tomography, during the late stage of the disease was 188.20±40 µm (range, 111–242 µm), which was significantly thinner than the fellow eye, 238.70±36.90 µm (range, 186–319 µm), P=0.008.ConclusionDUSN is a serious vision threatening disease, which may progress to profound vision loss in the later stage of the disease. Visualization of subretinal worm is usually not possible. Treatment with high-dose albendazole therapy and laser photocoagulation may alter the blood–retinal barrier and may be useful in achieving visual recovery.

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Section: Discussionmentioning

confidence: 64%

Clinical experience in treatment of diffuse unilateral subretinal neuroretinitis

Relhan

Pathengay

Raval

et al. 2015

OPTH

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“…This parasite must be considered a possible infection and cause of DUSN in urban settings. Secondly, it has been repeatedly stated by DUSN authorities that B. procyonis is less likely involved since none of the patients also had severe or fatal neurologic disease [5,17]. However, this is as it should be and is a major ongoing misconception about this infection, which clearly demonstrates dose-related differences in both animals and humans.…”

Section: Discussionmentioning

confidence: 99%

Baylisascaris Procyonis Induced Diffuse Unilateral Subacute Neuroretinitis in New York City

Saffra¹,

Perlman²,

Desai³

et al. 2010

J. Neuroparasitolog.

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Diffuse unilateral subacute neuroretinitis (DUSN) secondary to raccoon roundworm (Baylisascaris procyonis) infection has been reported in rural and suburban areas of North America and Europe with extant raccoon populations. Here, we present a case of Baylisascaris-induced DUSN from the densely populated borough of Brooklyn in New York City and alert urban ophthalmologists to consider this etiology even in areas not typically thought to be associated with endemic risk factors. Infected raccoons also occur in urban settings, and urban patients may be exposed in surrounding areas. Most patients with Baylisascaris ocular larva migrans-DUSN will not have concomitant neurologic disease; this fact and larval neurotropism are both misconceptions regarding this infection.

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“…The cause of inflammation remained unknown until association with a nematode was proposed in 1983 [ 2 , 3 ]. It typically presents unilaterally in children and young adults but rarely bilateral cases have been reported [ 4 ]. Entry of the worm into the eye occurs when nematode eggs, after being ingested, find their way into the eye haematogenously.…”

Section: Introductionmentioning

confidence: 99%

Case report: a case of diffuse unilateral subacute neuroretinitis (DUSN) in a child

et al. 2018

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BackgroundDiffuse unilateral subacute neuroretinitis (DUSN) is a rare cause of posterior uveitis in the United Kingdom. It typically presents unilaterally in children and young adults but rarely bilateral cases have been reported. It is also rare to have multiple worms in the same eye causing the clinical picture. In this article, we present a challenging case of DUSN in a young girl unresponsive to conventional treatments suggesting the possibility of multiple worms being present in the same eye.Case PresentationAn 8-year-old girl presented with a 2-month history of headaches. On occasions the headaches were associated with redness and watering of her left eye. She denied any visual loss or visual symptoms. Her visual acuity was reduced to 6/30 in her left eye. Fundal examination revealed a unilateral chorioretinitis. Investigation did not reveal a specific cause for the chorioretinitis. Over 15 months her visual acuity improved to 6/9 but the fundal appearance changed and a diagnosis of DUSN was made. She was treated with focal laser, systemic anti-helminthic and immunosuppressive treatments but continued to develop new, active areas of chorioretinitis, raising the possibility of multiple worms in the sub-retinal space. There is also a concern as to other central nervous system (CNS) involvement given her significant and ongoing headaches.ConclusionWe present a challenging case of DUSN in a young girl; a condition that remains rare in the UK. She was unresponsive to both focal laser and systemic anti-helminthic and immunosuppressive treatments suggesting the possibility of multiple worms being present in the sub-retinal space. This case highlights the difficulties often encountered in the treatment of DUSN, even when a worm can be identified. Her visual prognosis is poor as there was ongoing recurrence of active chorioretinitis.

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Diffuse Bilateral Subacute Neuroretinitis

Cited by 67 publications

References 8 publications

Clinical experience in treatment of diffuse unilateral subretinal neuroretinitis

Clinical experience in treatment of diffuse unilateral subretinal neuroretinitis

Baylisascaris Procyonis Induced Diffuse Unilateral Subacute Neuroretinitis in New York City

Case report: a case of diffuse unilateral subacute neuroretinitis (DUSN) in a child

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