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BACKGROUND: This manuscript describes a case of a patient with presumed ocular tuberculosis masquerading as multiple evanescent white dot syndrome. CASE PRESENTATION: A 32-year-old male patient presented with a complaint of reduced visual acuity in the left eye. Retinal fundus exam of the left eye revealed gray-whitish deep lesions predominantly nasal to the optic disc. The lesions were more clearly identifiable on fundus autofluorescence (FAF) imaging, fluorescein angiography (FA) and en face optical coherence tomography (OCT). FA also indicated retinal vasculitis and papillitis. Swept-source OCT B-scan demonstrated loss of the ellipsoid layer in the regions corresponding to the lesions detected by FAF. A positive tuberculin skin test (TST) confirmed presumed tuberculosis, and a related WDS diagnosis was made. Specific antituberculosis therapy was instituted with favorable anatomical recovery and visual outcome. CONCLUSION: Multiple evanescent white dot syndrome (MEWDS) may be manifestation of presumed ocular tuberculosis, and multimodal retinal exams can provide a better understanding of atypical diseases and their follow-up.
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ABSTRACT: Eyelid malignancies are frequently seen in clinical practice. There is a lack of studies that have assessed the features of these lesions in mixed population countries. The epidemiologic profile, clinical stage at presentation, management, and outcomes of patients with eyelid malignancies were assessed, in order to better understand the features of these lesions in a multi-ethnic country. The medical records of patients who underwent eyelid tumor excision in a tertiary service in Brazil, from 2014 to 2019 were retrospectively reviewed. It was recorded for each patient: age, gender, time of onset, location, diagnosis, management, and follow-up. The medical records of 298 patients who presented with eyelid tumors were evaluated and 67 (22.4%) were malignant. The mean age of patients with malignancies was 52.93âyears and 50% were male. Basal cell carcinoma was the most prevalent (61.2%), followed by squamous cell carcinoma (SCC) (29.9%) and sebaceous gland carcinoma (3%). The average time it took from appearance to surgical treatment was 3âyears; the lower eyelid was the most affected for both basal cell carcinoma and SCC; 70% of SCCs were locally invasive at presentation and metastasis occurred in 15%. Basal cell carcinoma was the most common eyelid malignancy observed, however, its frequency was lower when compared to other western countries. The advanced stage at presentation may reflect the lack of education of the population to seek early care, and the lack of specialized tertiary centers in remote areas, resulting in delayed diagnosis.
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Carcinoma Basocelular , Neoplasias Palpebrais , Neoplasias das Glândulas Sebáceas , Neoplasias Cutâneas , Carcinoma Basocelular/epidemiologia , Neoplasias Palpebrais/epidemiologia , Neoplasias Palpebrais/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
The aim of this study is to compare sleep characteristics between women with premenstrual syndrome (PMS) and a control group. The data were extracted from an epidemiologic survey conducted in Sao Paulo (EPISONO), Brazil, which used subjective assessments and objective polysomnography records to analyze subjects' sleep pattern. Subjective questionnaires used in this study were Women's Questionnaire, Pittsburgh Sleep Quality Index, Epworth sleepiness scale, Insomnia Severity Index and the general sleep questionnaire. The presence of PMS was obtained by a direct question in the Women's Questionnaire. The survey included 230 women, of whom 72.6% reported PMS. The PMS group had poorer sleep quality, a higher perception of unrefreshing sleep and more subthreshold insomnia. Participants with PMS had an increased total sleep time recorded by polysomnography and a lower saturation of peripheral oxygen. It is still unkown the mechanism behind PMS and the sleep-wake cycle. In the other hand, it is clear that PMS play a role in sleep, since women with this disorder has a poor quality of sleep and it is not refreshing. Better knowledge about this syndrome and its outcomes can help to improve their well-being and develop more precise therapeutic approaches.
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Síndrome Pré-Menstrual/diagnóstico , Síndrome Pré-Menstrual/epidemiologia , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/epidemiologia , Inquéritos e Questionários , Adulto , Brasil/epidemiologia , Estudos Transversais , Estudos Epidemiológicos , Feminino , Humanos , Pessoa de Meia-Idade , Polissonografia/métodos , Síndrome Pré-Menstrual/psicologia , Distribuição Aleatória , Transtornos do Sono-Vigília/psicologia , Adulto JovemRESUMO
Objective To present a case series of patients previously diagnosed as multiple sclerosis (MS) which were later confirmed as an alternative diagnosis, and describe the clinical and paraclinical signs that led to this change. Method Nine patients are described. We reviewed the patient’s clinical chart, magnetic resonance images (MRI) and cerebrospinal fluid. Results There was a mean of three typical symptoms of MS and four clinical red flags per patient. MRI red flags were found in 88,9% of all referrals, with a mean of 3 encountered per patient. Conclusion We identified that, not only the misdiagnosed patients did not fulfill MS diagnosis criteria, but also how the described red flags are a useful tool in the differentiation of MS from other diseases. This data is important for guiding future diagnosis, especially for general clinicians and neurologists, which directly interfere with the patient’s management, treatment, prognosis and quality of life.
Objetivo Apresentar uma série de casos de pacientes previamente diagnosticados como esclerose múltipla (EM) que tiveram um diagnóstico final alternativo, e descrever os sinais clínicos e paraclínicos que levaram à esta mudança. Método Nove pacientes encaminhados para confirmação diagnóstica de EM. Revisamos os prontuários, imagens de ressonância magnética (MRI) e líquido cefalorraquidiano. Resultados Houve uma média de três sintomas típicos de EM e quatro sinais de alerta por paciente. Sinais de alerta de ressonância magnética foram encontrados em 88,9% dos casos, com média de 3 por paciente. Conclusão Identificou-se que, não só os pacientes com diagnóstico incorreto não cumprem critérios de diagnóstico, mas também como os sinais de alerta já descritos são uma ferramenta útil na diferenciação de EM de outras doenças. Esta informação é importante para orientar a assertividade diagnóstica, especialmente para os clínicos e neurologistas gerais, com interferencia direta no tratamento, prognóstico e qualidade de vida do paciente.
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Esclerose Múltipla/diagnóstico , Diagnóstico Diferencial , Erros de Diagnóstico , Imageamento por Ressonância MagnéticaRESUMO
OBJECTIVE: To present a case series of patients previously diagnosed as multiple sclerosis (MS) which were later confirmed as an alternative diagnosis, and describe the clinical and paraclinical signs that led to this change. METHOD: Nine patients are described. We reviewed the patient's clinical chart, magnetic resonance images (MRI) and cerebrospinal fluid. RESULTS: There was a mean of three typical symptoms of MS and four clinical red flags per patient. MRI red flags were found in 88,9% of all referrals, with a mean of 3 encountered per patient. CONCLUSION: We identified that, not only the misdiagnosed patients did not fulfill MS diagnosis criteria, but also how the described red flags are a useful tool in the differentiation of MS from other diseases. This data is important for guiding future diagnosis, especially for general clinicians and neurologists, which directly interfere with the patient's management, treatment, prognosis and quality of life.