An Ironclad Diagnosis

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Identifier walsh_2014_s1_c1
Title An Ironclad Diagnosis
Creator Marc J. Dinkin; George Parlitsis; Sarju Patel; Alex Merkler; Audrey Schuetz; Cristiano Oliveira
Affiliation (MJD) (GP) (SP) (CO) Weill Cornell Medical College, Department of Ophthalmology New York, NY; (MJD) (AM) Weill Cornell Medical College, Department of Neurology New York, NY; (AS) Weill Cornell Medical College, Department of Pathology New York, NY
Subject Mycobacterium Haemophilum; Optic Chiasm; Demyelination; Chorioretinal Lesion; HIV
History A 43-year-old man with AIDS and a CD4 count of 4, non-compliant with HAART, presented with four days of headache, photophobia and vision loss in his left eye. There was a history of treated syphilis and CMV retinopathy. On neuro- ophthalmological examination, visual acuities were 20/40 OD (formerly 20/25) and count fingers OS (formerly 20/20). He could see 12/12 color plates OD and 0/12 OS and there was a relative afferent pupillary defect OS. The left eye was slightly injected with anterior chamber inflammation. Funduscopy demonstrated a raised focal area of chorioretinitis with a few satellite lesions and adjacent retinal hemorrhages. Humphrey visual field testing revealed a temporal hemianopsia OD and severe diffuse field loss OS. Optical coherence tomography (OCT) demonstrated extension of the retinal lesion from the outer retinal layer inward, suggestive of spread from the choroid. MRI brain with contrast revealed a 9 x 16 x 12 mm enhancing, T2 hyperintense mass centered in and expanding the optic chiasm, suggestive of an optic pathway glioma versus lymphoma per neuroradiology. There was T2 extension into the left optic tract.
Disease/Diagnosis Inflammatory demyelination of optic chiasm and tract due to infection by Mycobacterium haemophilum.
Presenting Symptom A 43-year-old man with AIDS and a CD4 count of 4, non-compliant with HAART, presented with four days of headache, photophobia and vision loss in his left eye.
Neuroimaging Optical Coherence Tomography; Magnetic Resonance Imaging
Treatment Azithromycin, rifabutin, moxifloxacin and prednisone.
Date 2014-03
References 1. Phowthongkum, Puengchitprapai, Udomsantisook, Tumwasorn, Suankratay, Spindle cell pseudotumor of the brain associated with Mycobacterium haemophilum and Mycobacterium simiae mixed infection in a patient with AIDS: the first case report, Int J Infect Dis,12(4):421-4, 2008 2. Sharma, Pradhan, Varma, Rathi, Irreversible blindness due to multiple tuberculomas in the suprasellar cistern, J Neuroophthalmol, 23(3):211-2, 2003 3. Garg, Paliwal, Malhotra, Tuberculous optochiasmatic arachnoiditis: a devastating form of tuberculous meningitis. Expert Rev Anti Infect Ther, 9:719-29, 2011 4. Lindeboom, Bruijnesteijn van Coppenraet, van Soolingen, Prins, Kuijper, Clinical manifestations, diagnosis, and treatment of Mycobacterium haemophilum infections, Clin Microbiol Rev, 24(4):701-17, 2011
Language eng
Format application/pdf
Type Image
Source 46th Annual Frank Walsh Society Meeting
Relation is Part of NANOS Annual Meeting Frank B. Walsh Sessions; 2014
Collection Neuro-Ophthalmology Virtual Education Library: Walsh Session Annual Meeting Archives: https://novel.utah.edu/Walsh/
Publisher North American Neuro-Ophthalmology Society
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management Copyright 2014. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s6c56hfz
Setname ehsl_novel_fbw
ID 179187
Reference URL https://collections.lib.utah.edu/ark:/87278/s6c56hfz
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