Rationale:Tuberculous meningitis(TBM)is severe extrapulmonary tuberculosis that can cause poor outcomes without timely treatment.We report a case of presumed TBM that presented solely ocular complaints without other n...Rationale:Tuberculous meningitis(TBM)is severe extrapulmonary tuberculosis that can cause poor outcomes without timely treatment.We report a case of presumed TBM that presented solely ocular complaints without other neurological features.Patient's concerns:A 71-year-old man presented with a sudden central visual defect in both eyes for 10 days.Fundoscopy showed bilateral hyperaemic swelling disc with infiltrates.Diagnosis:A diagnosis of presumptive TBM was made with Mantoux test reading 15 mm,elevated erythrocyte sedimentation rate,subdural effusion on CT scan,and high opening pressure.Intervention:Anti-tuberculous treatment.Outcomes:Bilateral vision improved and optic discs swelling resolved.Lessons:Early recognition of TBM with optic nerve infiltration is crucial for prompt treatment that may lead to a good prognosis.Neuroimaging will facilitate the diagnosis when other investigations show a borderline result.展开更多
Rationale:Infectious keratopathy is an ocular emergency with the potential to cause irreversible blindness.Patient's concerns:A 63-year-old diabetic man presented with a 3-day history of painful red right eye.He h...Rationale:Infectious keratopathy is an ocular emergency with the potential to cause irreversible blindness.Patient's concerns:A 63-year-old diabetic man presented with a 3-day history of painful red right eye.He had a history of multiple ocular surgeries in the affected eye without recent ocular trauma.Diagnosis:Infective crystalline keratopathy secondary to Citrobacter koseri.Interventions:Topical corticosteroids were discontinued,and dual topical antibiotic therapy of moxifloxacin 5%and gentamycin 0.3%were applied.Outcomes:Twelve hours after the start of treatment,the crystalline nature of the infiltrate disappeared,with enlargement of the epithelial defect.The antibiotic regime was continued and the lesion healed within a week of presentation with residual scarring.Lessons:Infective crystalline keratopathy classically presents with intrastromal branching fern-like opacities and minimal anterior segment inflammation in an immunosuppressed eye.The mainstay of management is corticosteroid discontinuation and the administration of empirical antibiotics until the results of the culture and sensitivity are available.In Citrobacter-related cases,treatment may result in a suppurative appearance before healing of the lesion.展开更多
文摘Rationale:Tuberculous meningitis(TBM)is severe extrapulmonary tuberculosis that can cause poor outcomes without timely treatment.We report a case of presumed TBM that presented solely ocular complaints without other neurological features.Patient's concerns:A 71-year-old man presented with a sudden central visual defect in both eyes for 10 days.Fundoscopy showed bilateral hyperaemic swelling disc with infiltrates.Diagnosis:A diagnosis of presumptive TBM was made with Mantoux test reading 15 mm,elevated erythrocyte sedimentation rate,subdural effusion on CT scan,and high opening pressure.Intervention:Anti-tuberculous treatment.Outcomes:Bilateral vision improved and optic discs swelling resolved.Lessons:Early recognition of TBM with optic nerve infiltration is crucial for prompt treatment that may lead to a good prognosis.Neuroimaging will facilitate the diagnosis when other investigations show a borderline result.
文摘Rationale:Infectious keratopathy is an ocular emergency with the potential to cause irreversible blindness.Patient's concerns:A 63-year-old diabetic man presented with a 3-day history of painful red right eye.He had a history of multiple ocular surgeries in the affected eye without recent ocular trauma.Diagnosis:Infective crystalline keratopathy secondary to Citrobacter koseri.Interventions:Topical corticosteroids were discontinued,and dual topical antibiotic therapy of moxifloxacin 5%and gentamycin 0.3%were applied.Outcomes:Twelve hours after the start of treatment,the crystalline nature of the infiltrate disappeared,with enlargement of the epithelial defect.The antibiotic regime was continued and the lesion healed within a week of presentation with residual scarring.Lessons:Infective crystalline keratopathy classically presents with intrastromal branching fern-like opacities and minimal anterior segment inflammation in an immunosuppressed eye.The mainstay of management is corticosteroid discontinuation and the administration of empirical antibiotics until the results of the culture and sensitivity are available.In Citrobacter-related cases,treatment may result in a suppurative appearance before healing of the lesion.
