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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 showing the extensive thinning of the superior sclera and secondary anterior staphyloma formation.
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Figure 3: Colour photograph of the right eye showing the extensive thinning of the superior sclera and secondary anterior staphyloma formation.

Mentions: By the fourth month a large anterior staphyloma had formed in the right eye between 11 and 4 o'clock positions (Fig 3). The eye remained comfortable and she was treated with g.maxidex qid and g timoptol 0.25% bid. At the last review, six months after presentation, the eye was comfortable. The vision remained PL on the right and 6/6 on the left. The intraocular pressure was 12 mmHg on g timoptol 0.25% b d on the right. Specific immunological tests conducted 5 months following the septicaemia showed normal levels of IgA, IgB, IgC, CD19/B cells and CD16/K cells. Pneumococcal antibodies were noted to be below the normal range.


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 showing the extensive thinning of the superior sclera and secondary anterior staphyloma formation.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Colour photograph of the right eye showing the extensive thinning of the superior sclera and secondary anterior staphyloma formation.
Mentions: By the fourth month a large anterior staphyloma had formed in the right eye between 11 and 4 o'clock positions (Fig 3). The eye remained comfortable and she was treated with g.maxidex qid and g timoptol 0.25% bid. At the last review, six months after presentation, the eye was comfortable. The vision remained PL on the right and 6/6 on the left. The intraocular pressure was 12 mmHg on g timoptol 0.25% b d on the right. Specific immunological tests conducted 5 months following the septicaemia showed normal levels of IgA, IgB, IgC, CD19/B cells and CD16/K cells. Pneumococcal antibodies were noted to be below the normal range.

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