| Identifier |
walsh_2014_s1_c1-1 |
| Title |
An Ironclad Diagnosis |
| Creator |
Marc J. Dinkin, George Parlitsis, Sarju Patel, Alexander E. Merkler, Audrey Schuetz, Cristiano Oliveira |
| 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 |
Case presented at the NANOS 2014 Walsh Session, March 2 |
| Collection |
Neuro-Ophthalmology Virtual Education Library - Walsh Session Annual Meeting Archives https://novel.utah.edu/Walsh/index3.html |
| Publisher |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-6308 |
| Rights Management |
Copyright 2014. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6mh0m4h |
| Setname |
ehsl_novel_fbw |
| ID |
179216 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6mh0m4h |
