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Optic atrophy, necrotizing anterior scleritis and keratitis presenting in association with Streptococcal Toxic Shock Syndrome: a case report.

Papageorgiou KI, Ioannidis AS, Andreou PS, Sinha AJ - J Med Case Rep (2008)

Bottom Line: The vision was reduced to hand movements (HM).She subsequently developed a necrotizing anterior scleritis.We recommend increased awareness of the potential risks of these patients developing severe ocular involvement.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ophthalmology, Mid Essex NHS Trust, Court Road, Chelmsford, UK. papageorgiouk@doctors.org.uk

ABSTRACT

Introduction: We report a case of optic atrophy, necrotizing anterior scleritis and keratitis presenting in a patient with Streptococcal Toxic Shock Syndrome.

Case presentation: A 43-year-old woman developed streptococcal toxic shock syndrome secondary to septic arthritis of her right ankle. Streptococcus pyogenes (b-haemolyticus Group A) was isolated from blood cultures and joint aspirate. She was referred for ophthalmology review as her right eye became injected and the pupil had become unresponsive to light whilst she was in the Intensive Therapy Unit (ITU). The iris appeared atrophic and was mid-dilated with no direct or consensual response to light. Three zones of sub-epithelial opacification where noted in the cornea. There where extensive posterior synechiae. Indirect ophthalmoscopy showed a pale right disc. The vision was reduced to hand movements (HM). A diagnosis of optic atrophy was made secondary to post-streptococcal uveitis. She subsequently developed a necrotizing anterior scleritis.

Conclusion: This case illustrates a previously unreported association of optic atrophy, necrotizing anterior scleritis and keratitis in a patient with post-streptococcal uveitis. This patient had developed Streptococcal Toxic Shock Syndrome secondary to septic arthritis. We recommend increased awareness of the potential risks of these patients developing severe ocular involvement.

No MeSH data available.


Related in: MedlinePlus

Colour photograph of the right eye indicating the initial thinning of the sclera at the superior limbus.
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Figure 2: Colour photograph of the right eye indicating the initial thinning of the sclera at the superior limbus.

Mentions: She was referred for ophthalmology assessment on day 36 of her admission to ITU as her right eye appeared injected and her right pupil was unresponsive to light. The visual acuity was reduced to hand movements (HM) on the right and was 6/6 on the left. The right eye was comfortable despite significant ciliary injection. She was examined by the bed side using a hand held slit lamp. On examination, the anterior chamber was deep and appeared quiet. The corneal surface appeared irregular with three distinct zones of sub-epithelial opacification. There was no corneal staining with 2% fluorescein. The right iris appeared atrophic and paler in colour. The pupil was fixed in mid-dilation with extensive posterior synechiae at 360 degrees (Fig 1). There were no transillumination defects or evidence of rubeosis iridis. There was no hypopyon. The intraocular pressure was elevated measuring 24 mmHg in the right eye. On indirect ophthalmoscopy the view of the fundus was clear with no evidence of inflammatory membranes in the vitreous. The retinal vessels appeared normal and there were no areas of intraretinal haemorrhage or pallor. The right optic disc was pale. The left eye was normal except for a small cotton wool spot above the left optic disc. A diagnosis of right optic atrophy in association with post-streptococcal uveitis was made and she was commenced on g maxidex hourly, g. cyclopentolate tds and g Timolol 0.25%. On day 48 the vision was perception of light (PL) in the right eye. Thinning of the superior sclera was noted and she was maintained on topical steroids (Fig 2). By this stage she had undergone extensive limb amputations including two below-knee amputations and bilateral amputations of all digits due to extensive vasculitic necrosis. The medical team were reluctant to treat her with oral steroids due to the risk of secondary infections in the healing wounds.


Optic atrophy, necrotizing anterior scleritis and keratitis presenting in association with Streptococcal Toxic Shock Syndrome: a case report.

Papageorgiou KI, Ioannidis AS, Andreou PS, Sinha AJ - J Med Case Rep (2008)

Colour photograph of the right eye indicating the initial thinning of the sclera at the superior limbus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2277429&req=5

Figure 2: Colour photograph of the right eye indicating the initial thinning of the sclera at the superior limbus.
Mentions: She was referred for ophthalmology assessment on day 36 of her admission to ITU as her right eye appeared injected and her right pupil was unresponsive to light. The visual acuity was reduced to hand movements (HM) on the right and was 6/6 on the left. The right eye was comfortable despite significant ciliary injection. She was examined by the bed side using a hand held slit lamp. On examination, the anterior chamber was deep and appeared quiet. The corneal surface appeared irregular with three distinct zones of sub-epithelial opacification. There was no corneal staining with 2% fluorescein. The right iris appeared atrophic and paler in colour. The pupil was fixed in mid-dilation with extensive posterior synechiae at 360 degrees (Fig 1). There were no transillumination defects or evidence of rubeosis iridis. There was no hypopyon. The intraocular pressure was elevated measuring 24 mmHg in the right eye. On indirect ophthalmoscopy the view of the fundus was clear with no evidence of inflammatory membranes in the vitreous. The retinal vessels appeared normal and there were no areas of intraretinal haemorrhage or pallor. The right optic disc was pale. The left eye was normal except for a small cotton wool spot above the left optic disc. A diagnosis of right optic atrophy in association with post-streptococcal uveitis was made and she was commenced on g maxidex hourly, g. cyclopentolate tds and g Timolol 0.25%. On day 48 the vision was perception of light (PL) in the right eye. Thinning of the superior sclera was noted and she was maintained on topical steroids (Fig 2). By this stage she had undergone extensive limb amputations including two below-knee amputations and bilateral amputations of all digits due to extensive vasculitic necrosis. The medical team were reluctant to treat her with oral steroids due to the risk of secondary infections in the healing wounds.

Bottom Line: The vision was reduced to hand movements (HM).She subsequently developed a necrotizing anterior scleritis.We recommend increased awareness of the potential risks of these patients developing severe ocular involvement.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ophthalmology, Mid Essex NHS Trust, Court Road, Chelmsford, UK. papageorgiouk@doctors.org.uk

ABSTRACT

Introduction: We report a case of optic atrophy, necrotizing anterior scleritis and keratitis presenting in a patient with Streptococcal Toxic Shock Syndrome.

Case presentation: A 43-year-old woman developed streptococcal toxic shock syndrome secondary to septic arthritis of her right ankle. Streptococcus pyogenes (b-haemolyticus Group A) was isolated from blood cultures and joint aspirate. She was referred for ophthalmology review as her right eye became injected and the pupil had become unresponsive to light whilst she was in the Intensive Therapy Unit (ITU). The iris appeared atrophic and was mid-dilated with no direct or consensual response to light. Three zones of sub-epithelial opacification where noted in the cornea. There where extensive posterior synechiae. Indirect ophthalmoscopy showed a pale right disc. The vision was reduced to hand movements (HM). A diagnosis of optic atrophy was made secondary to post-streptococcal uveitis. She subsequently developed a necrotizing anterior scleritis.

Conclusion: This case illustrates a previously unreported association of optic atrophy, necrotizing anterior scleritis and keratitis in a patient with post-streptococcal uveitis. This patient had developed Streptococcal Toxic Shock Syndrome secondary to septic arthritis. We recommend increased awareness of the potential risks of these patients developing severe ocular involvement.

No MeSH data available.


Related in: MedlinePlus