Poststreptococcal syndrome mimicking conjunctival lymphoma

Abstract

BackgroundPoststreptococcal syndrome (PSS) can be a consequence of nonpurulent primary infection with group A streptococci (GAS). Postreptococcal uveitis is a well recognized entity with quite a few descriptions in the literature, but so far no conjunctival involvement has been reported.The aim of the study is to present a rare case of postreptococcal conjunctival lesions mimicking a lymphoma.Case presentation19-years-old Caucasian female presented with pink, nodular infiltrates in the right conjunctiva that occurred a few months after upper respiratory tract infection and tonsillectomy. Histopathological examination of collected lesion samples revealed inflammatory reaction with lymphocytes proliferation and failed to rule out a myeloma. Complementary flow-cytometry did not show monoclonal proliferation of lymphocytes B. During follow-up we observed the complete regression of conjunctival lesions after the benzyl penicillin treatment prescribed by ENT specialist due to elevated plasma ASO levels. Therefore, we suppose that those lesions must have represented a part of poststreptococcal syndrome.ConclusionsTo conclude, this is, to the best of our knowledge, the first report of conjunctival involvement in the course of PSS related to group A streptococci.

Optical Coherence Tomography Findings in Nodular Anterior Scleritis due to Post-Streptococcal Syndrome

“…Findings supporting the diagnosis of PSS scleritis were the history of ARF, pharyngitis, biopsy results, the high erythrocyte sedimentation rate, the raised ASO antibody titer, the evidence of streptococcal infections, the rapid response to penicillin, the early recurrence when the patient stopped penicillin treatment, and the negative results for all main diseases responsible for scleritis. [1,[6][7][8] Reported cases of an ocular involvement of PSS include scleritis, in addition to uveitis, and rarely episcleritis, conjunctivitis, Brown's syndrome, optic disc edema, posterior scleritis, and glaucoma. [2,[7][8][9][10][11][12] However, previous studies reported PSS as an uncommon cause of uveitis or scleral inflammation.…”

“…[1,[6][7][8] Reported cases of an ocular involvement of PSS include scleritis, in addition to uveitis, and rarely episcleritis, conjunctivitis, Brown's syndrome, optic disc edema, posterior scleritis, and glaucoma. [2,[7][8][9][10][11][12] However, previous studies reported PSS as an uncommon cause of uveitis or scleral inflammation. [2] To our knowledge, PSS was not figured among the possible causes of nodular anterior scleritis.…”

“…[5] In this case, OCT findings strongly suggested non-necrotizing form of nodular scleritis as described in the previous reports. [1,[6][7][8]13] Sometimes, OCT can suggest the etiology of anterior scleritis. Common associated diseases were found in the cases of non-necrotizing noninfectious scleritis.…”

“…Such a finding have been previously reported. [8] Penicillin prophylaxis is needed to prevent PSS complications and recurrence. [1,7,8,12] Presumed PSS scleritis may be among refractory cases to standard corticosteroid treatment and may require penicillin for treatment.…”

Case report: a diagnostically challenging conjunctival mass caused by the Epstein-Barr virus

“…The majority of cases are observed in the first 10 years of life and progress rapidly giving rise to visual disturbances due to proptosis or limited EOM [ 14 , 15 ]. Other differentials to consider include malignant processes such as ocular infiltration secondary to multiple myeloma or infective causes such as nodular anterior scleritis, chlamydia, herpetic infection, papilloma, tuberculosis and migratory phlyctenulosis [ 16 ].…”