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Objective: To describe the clinical features and outcomes of patients with uveitis associated with juvenile idiopathic arthritis (JIA) and idiopathic uveitis. Methods: This was an observational, retrospective study, conducted in a tertiary center. Patients under 18 years old who experienced at least one episode of uveitis and followed between 2000 and 2019 were included. Results: A total of 82 patients were included, of whom 43 had idiopathic uveitis and 39 had uveitis associated with JIA. Anterior uveitis was the primary site of ocular inflammation (76.8%) and occurred in 24 and 39 patients with idiopathic uveitis and uveitis associated with JIA arthritis, respectively (p=0.02). The complete response to corticotherapy was more frequent in uveitis associated with JIA (p=0.001). Total and partial responses to biological disease modifying antirheumatic drugs were more frequent in uveitis associated with JIA (p=0.025) and idiopathic uveitis (p=0.045), respectively. There were 203 complications: cataracts were more frequently present in idiopathic uveitis (p=0.05), while synechiae was more frequent in uveitis associated with JIA (p=0.02). Conclusion: Idiopathic uveitis and uveitis associated JIA frequently follow a chronic course and an increased risk of visual loss in childhood. The uveitis associated with JIA showed better response to systemic corticotherapy and total response to biologic disease modifying antirheumatic drugs more frequently. [ABSTRACT FROM AUTHOR]

A 41 year-old man presented with unilateral vision loss for a week and constitutional symptoms for 3 months. Ophthalmic evaluation revealed cotton wool spots on the right eye and widespread retinal necrosis and hemorrhage on the left eye, suggestive of cytomegalovirus uveitis and HIV infection and retinopathy, and confirmed by serology. The patient was treated with ganciclovir and highly active antiretroviral therapy and preserved contralateral vision. Clinicians should be aware of uveitis and retinopathies to prevent irreversible vision loss and systemic conditions. [ABSTRACT FROM AUTHOR]

Uveitis in Behçet's disease (BD) is frequent (40% of cases) and is a major cause of morbidity. The age of onset of uveitis is between 20 and 30 years. Ocular involvement includes anterior, posterior or panuveitis. It is non-granulomatous. Uveitis may be the first sign of the disease in 20% of cases or it may appear 2 or 3 years after the first symptoms. Panuveitis is the most common presentation and is more commonly found in men. Bilateralisation usually occurs on average 2 years after the first symptoms. The estimated risk of blindness at 5 years is 10–15%. BD uveitis has several ophthalmological features that distinguish it from other uveitis. The main goals in the management of patients are the rapid resolution of intraocular inflammation, prevention of recurrent attacks, achievement of complete remission, and preservation of vision. Biologic therapies have changed the management of intraocular inflammation. The aim of this review is to provide an update previous article by our team on pathogenesis, diagnostic approaches, identification of factors associated with relapse and the therapeutic strategy of BD uveitis. [ABSTRACT FROM AUTHOR]

This French National Diagnostic and Care Protocol (NDPC) includes both pediatric and adult patients with non-infectious chronic uveitis (NICU) or non-infectious recurrent uveitis (NIRU). NICU is defined as uveitis that persists for at least 3 months or with frequent relapses occurring less than 3 months after cessation of treatment. NIRU is repeated episodes of uveitis separated by periods of inactivity of at least 3 months in the absence of treatment. Some of these NICU and NIRU are isolated. Others are associated with diseases that may affect various organs, such as uveitis associated with certain types of juvenile idiopathic arthritis, adult spondyloarthropathies or systemic diseases in children and adults such as Behçet's disease, granulomatoses or multiple sclerosis. The differential diagnoses of pseudo-uveitis, sometimes related to neoplasia, and uveitis of infectious origin are discussed, as well as the different forms of uveitis according to their main anatomical location (anterior, intermediate, posterior or panuveitis). We also describe the symptoms, known physiopathological mechanisms, useful complementary ophthalmological and extra-ophthalmological examinations, therapeutic management, monitoring and useful information on the risks associated with the disease or treatment. Finally, this protocol presents more general information on the care pathway, the professionals involved, patient associations, adaptations in the school or professional environment and other measures that may be implemented to manage the repercussions of these chronic diseases. Because local or systemic corticosteroids are usually necessary, these treatments and the risks associated with their prolonged use are the subject of particular attention and specific recommendations. The same information is provided for systemic immunomodulatory treatments, immunosuppressive drugs, sometimes including anti-TNFα antibodies or other biotherapies. Certain particularly important recommendations for patient management are highlighted in summary tables. [ABSTRACT FROM AUTHOR]

De nombreux virus sont responsables d'atteintes des différentes tuniques oculaires. Parmi les infections virales de surface oculaire, les conjonctivites sont principalement causées par les adénovirus et les kératites, par les herpèsvirus. Les infections virales des tissus intraoculaires, ou uvéites virales, dont les tableaux cliniques dépendent de l'état d'immunodépression du sujet, sont principalement dues aux herpèsvirus et au virus de la rubéole. La PCR est au premier plan du diagnostic. L'intérêt de la recherche de synthèse intraoculaire d'IgG spécifiques est limité à certaines indications, en particulier la suspicion d'uvéite de Fuchs. Lorsque l'atteinte oculaire est associée à un tableau clinique systémique, les techniques de diagnostic sont celles de l'infection suspectée. Many viruses are responsible of ocular diseases. Among viral infections of the ocular surface, conjunctivitis is typically caused by Adenoviruses and keratitis, by herpesviruses. Viral infections of intraocular tissues or viral uveitis, whose clinical pictures depend on the subject's state of immunosuppression, are mainly due to herpesviruses and rubella virus. PCR is at the forefront of the diagnosis of these ocular viral infections. Virus-specific intraocular IgG production analysis is limited to some indications, in particular in case of Fuchs uveitis. When the ocular involvement is associated with a systemic clinical picture, diagnostic tests should be extended to other suspected viral infections. [ABSTRACT FROM AUTHOR]

La sarcoïdose est l'une des principales maladies inflammatoires affectant l'œil. Toutes les structures oculaires peuvent être touchées, mais l'uvéite est la principale manifestation responsable de la perte de vision. L'uvéite sarcoïdosique antérieure se présente classiquement sous la forme de précipités cornéens en graisse de mouton, de nodules iriens et de synéchies postérieures. L'atteinte du segment postérieur se manifeste le plus souvent sous la forme d'une hyalite, d'une vascularite veineuse non occlusive et d'une choroïdite. L'œdème maculaire cystoïde est une complication fréquente qui menace la fonction visuelle. Les patients présentant une uvéite cliniquement isolée au moment du diagnostic développent rarement d'autres atteintes de la maladie. Un diagnostic plus précoce et un plus large éventail de thérapeutiques (incluant les implants intravitréens) en particulier au cours de la dernière décennie, ont permis de réduire le risque de cécité. Les corticostéroïdes sont la pierre angulaire du traitement des uvéites sarcoïdosiques, mais jusqu'à 30 % des patients requièrent un traitement d'épargne cortisonique, en raison d'une corticodépendance à dose élevée ou d'effets secondaires de la corticothérapie. Le méthotrexate est l'immunosuppresseur de référence. Comme pour les autres uvéites chroniques non-antérieures, les anti TNF-α sont utiles pour la prise en charge des formes réfractaires. Sarcoidosis is one of the leading causes of inflammatory eye disease. All ocular structures can be affected, but uveitis is the main manifestation responsible for vision loss in ocular sarcoidosis. Typical sarcoid anterior uveitis presents with mutton-fat keratic precipitates, iris nodules, and posterior synechiae. Posterior involvement includes vitritis, vasculitis, and choroidal lesions. Cystoid macular edema is the most important and sight-threatening consequence of sarcoid uveitis. Patients with clinically isolated uveitis at diagnosis rarely develop other organ involvement. Even though, ocular sarcoidosis can have a severe impact on visual prognosis, early diagnosis and a wider range of available therapies (including intravitreal implants) have lessened the functional impact of the disease, particularly in the last decade. Corticosteroids are the cornerstone of treatment for sarcoidosis, but up to 30% of patients achieve remission with requiring high-dose systemic steroids. In these cases, the use of steroid-sparing immunosuppressive therapy (such as methotrexate) is unavoidable. Among these immunosuppressive treatments, anti TNF-α drugs have been a revolution in the management of non-infectious uveitis. [ABSTRACT FROM AUTHOR]

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Ocular toxoplasmosis is the most common cause of posterior uveitis worldwide, with an estimated incidence of 8.4%. It follows infection by the ubiquitous parasite Toxoplasma gondii. The diagnosis is based on clinical examination looking for uveitis and most often retinochoroiditis. Microbiological confirmation is an element of positive diagnosis. The indications for treatment remain debated, whether for acute forms or recurrences., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Tropical regions are characterized by a hot and humid climate that promotes the emergence or resurgence of endemic or epidemic levels of microorganisms such as viruses. Emerging viral infections are mostly inapparent, mild, or non-specific (flu-like syndrome), but they may include serious, potentially disabling or life-threatening complications. A wide array of ocular manifestations has been recently described in association with specific emerging viral infections, including arboviruses, Human T-cell Lymphotropic Virus Type 1 (HTLV-1), and Ebola. Emerging viral disease should be considered in the differential diagnosis of ocular inflammatory conditions in patients living in or returning from endemic regions. Diagnosis of emerging viral infection is confirmed with either real time polymerase chain reaction or serology. Management consists of supportive care, as there are currently no specific antiviral drug options. Corticosteroids are often used for the treatment of associated ocular inflammation. Most patients have a good visual prognosis, but there may be permanent visual impairment in some due to ocular structural complications. Prophylactic measures are essential to prevent human infection and disease., Competing Interests: Déclaration de liens d’intérêts Les auteurs déclarent ne pas avoir de liens d’intérêts., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

La colchicine est un médicament à marge thérapeutique étroite qui n'a pas les effets indésirables des corticoïdes et des immunosuppresseurs. Son utilisation dans les atteintes oculaires inflammatoires non sévères hors de la maladie de Behcet n'a pas été étudiée. Nous avons inclus les patients vus dans le service de médecine interne du CHU de Dijon consécutivement entre septembre 2020 et septembre 2021 s'ils avaient reçu de la colchicine au cours de leur pathologie. Les patients suspects de maladie de Behçet étaient exclus. L'efficacité du traitement a été étudiée chez les patients pour lesquels la maladie évoluait depuis au moins un an et qui avaient reçu plus d'un an de colchicine. Le succès du traitement était défini par une diminution de 50 % du nombre de poussées annuelles sous colchicine. Seize patients ont été inclus (9 femmes et 7 hommes). Il s'agissait d'uvéites antérieures récidivantes (n = 10), de sclérites récidivantes (n = 5) et d'une uvéite intermédiaire. Les atteintes ophtalmologiques n'étaient ni sévères ni compliquées. Tous patients confondus, le ratio annuel de poussées (IIQ) passait de 1,8 (0,8 – 3,5) à 0,3 (0 – 1,6), (p = 0,06). La colchicine était considérée comme efficace chez trois patients sur 10 analysables. Chez un seul patient, le traitement a été arrêté pour effets indésirables au bout de six semaines. Au vu du rapport bénéfice risque intéressant de la colchicine, il semble opportun de s'intéresser à cette molécule dans les uvéites antérieures non granulomateuses et sclérites récidivantes non sévères. Colchicine is a narrow therapeutic margin drug that does not have the adverse effects of corticosteroids and immunosuppressants. Its use in non-severe ocular inflammatory disease excluding Behcet's disease has not been studied. We included patients seen in the internal medicine department of Dijon University Hospital consecutively between September 2020 and September 2021 if they had received colchicine during their pathology. Patients with suspected Behçet's disease were excluded. Treatment efficacy was studied in patients with at least one year of disease progression who had received more than one year of colchicine. Successful treatment was defined as a 50 % reduction in the number of annual relapses on colchicine. Sixteen patients were included (9 women and 7 men). They had recurrent anterior uveitis (n = 10), recurrent scleritis (n = 5) and intermediate uveitis. Opthalmological involvement was neither severe nor complicated. All patients combined, the annual relapse ratio (ARR) decreased from 1.8 (0.8–3.5) to 0.3 (0–1.6), (P = 0.06). Colchicine was considered effective in three of 10 analyzable patients. In only one patient, treatment was stopped for adverse effects after six weeks. In view of the interesting benefit-risk ratio of colchicine, it seems appropriate to focus on this molecule in non-granulomatous anterior uveitis and non-severe recurrent scleritis. [ABSTRACT FROM AUTHOR]

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Punctuate Outer Retinal Toxoplasmosis (PORT) is a rare variant of toxoplasma chorioretinitis. We report the case of a 21-year-old patient presenting with visual blur of the left eye (LE). The examination found a corrected visual acuity (VA) at 3/10th, a quit anterior segment and a 1+ vitreous haze. Fundus examination showed a suprafoveolar yellowish-white lesions associated to multiple peripheral atrophic and pigmented ones. Visual acuity of the right eye was 10/10th with a calm anterior segment. Fundus examination depicted an upper temporal cicatricial pigmented lesion. Multimodal imaging of LE objectified a PORT. The patient received antibiotic and corticosteroids with favorable clinical and functional outcome. Final VA reached 10/10 at day ten. This case illustrates the importance of multimodal imaging in the differentiation of PORT from the white dots syndrome and other unilateral retinitis. [ABSTRACT FROM AUTHOR]

Introduction: Diverses manifestations extra-articulaires (MEA) ou systémiques peuvent survenir au cours d’une spondyloarthrite (SpA). Elles peuvent même inaugurer la maladie. L’atteinte oculaire est la manifestation extraarticulaire la plus fréquente au cours des spondyloarthrites (SpA). L’objectif de cette étude était de déterminer la fréquence et les caractéristiques des manifestations oculaires chez des patients atteints de SpA en Guinée. Matériels et méthodes: Etude transversale descriptive au service de Rhumatologie de Conakry et au service d’Ophtalmologie de l’hôpital des armées de Conakry du 1er Janvier 2019 au 30 Juin 2020. Tous les patients ayant une spondyloarthrite selon les critères d’ASAS et de New York Modifié ont été inclus. Résultats: Cinquante patients ont été inclus parmi lesquels 19 (38%) avaient des lésions oculaires (38%). Il s’agissait de 13(68,4%) hommes et de 6 (31,6%) femmes. L’âge moyen était de 32,9 ± 12,7 ans. Les manifestations oculaires étaient dominées par les uvéites (94,7%). Elles se caractérisaient par une localisation à prédominance antérieure (77,7%), unilatérale (73,7%). Les complications étaient à type de synéchies iridocristalliniennes (15,8%), de cataracte (15,8%) et d’hypertonie oculaire (10,5%). L’uvéite précédait les premiers symptômes de la SpA dans 52,6 % et elle survenait après la SpA dans 42,1%. Les deux maladies étaient concomitantes chez 5,3% des patients. La spondylarthrite ankylosante était le sous type des SpA le plus fréquent (84,2%). Conclusion: Les uvéites étaient fréquentes au cours des spondyloarthrites. La spondylarthrite ankylosante était le soustype le plus concerné dans notre contexte. Des études de plus grande ampleur sont nécessaires pour mieux explorer la question.

• La prévalence de l'uvéite antérieure aiguë (UAA) dans la population du registre REGISPONSER s'élevait à 16,2 %. • Les patients qui présentaient une uvéite antérieure aiguë comme premier symptôme affichaient une meilleure capacité fonctionnelle et des dommages structuraux moins marqués comparativement aux patients dont l'uvéite était postérieure à l'apparition des premiers symptômes rhumatismaux. • La date de survenue de l'uvéite antérieure aiguë n'a montré aucun effet sur les traitements administrés. Décrire la date de survenue de l'uvéite antérieure aiguë (UAA) par rapport aux premiers symptômes rhumatismaux et déterminer son association à l'évolution de la spondyloarthrite (SpA) en ce qui concerne l'activité, les lésions structurelles, la capacité fonctionnelle et le traitement. Il s'agit d'une étude transversale s'appuyant sur les données du registre REGISPONSER (registre national des SpA de la société espagnole de rhumatologie). Trente et un centres ont participé et les patients atteints de SpA selon les critères de l'ESSG ont été inclus entre 2004 et 2007. La classification des patients s'est faite selon la date de survenue de l'uvéite par rapport aux premiers signes rhumatismaux (antérieure, simultanée ou postérieure à l'apparition des symptômes). Nous avons comparé les caractéristiques cliniques, l'activité de la maladie, les lésions radiographiques et la capacité fonctionnelle entre les « UAA survenues avant/simultanément aux premiers symptômes rhumatismaux » et les « UAA survenues après les premiers symptômes ». Pour finir, nous avons analysé l'impact de la date de survenue de l'UAA sur le recours aux anti-rhumatismaux modificateurs de la maladie conventionnels et biologiques (respectivement DMARDcs et DMARDb) Au total, 2367 patients ont été inclus dans le registre REGISPONSER avec une prévalence de l'UAA de 16,2 % (379 patients). Les patients dont l'UAA précédait/accompagnait les premiers signes rhumatismaux (n = 59) affichaient une meilleure capacité fonctionnelle (BASFI, OR : 0,85 [0,73–0,99]) et des lésions structurelles moins marquées (BASRI au rachis, OR : 0,88 [0,79–0,99]). De plus, dans ce groupe de patients, l'âge d'apparition des premiers symptômes de SpA était plus avancé (OR : 1,05 [1,02–1,09]) et le délai diagnostique plus court (OR : 0,90 [0,84–0,96]) comparativement aux patients ayant développé une UAA après l'apparition des manifestations rhumatismales (n = 229). Aucune différence statistiquement significative concernant l'utilisation des DMARD n'a été observée (27,9 % vs 23,2 % pour l'utilisation des DMARDcs et 15,3 % vs 20,3 % pour l'utilisation des DMARDb chez les patients avec une UAA survenue respectivement avant/simultanément vs après les premiers signes rhumatismaux). Les patients qui présentaient un premier épisode d'UAA avant/simultanément aux premiers symptômes rhumatismaux avaient une forme moins sévère de la maladie (meilleure capacité fonctionnelle et dommages structuraux limités) et un délai diagnostique plus court ; cependant, la date de survenue de l'UAA n'a montré aucun effet sur les traitements administrés. [ABSTRACT FROM AUTHOR]

Purpose: Sarcoid uveitis is rare in the pediatric population. Early diagnosis is challenging and is crucial, due to more severe complications. Diagnosis relies on various criteria, including elevated angiotensin-converting enzyme (ACE) levels. The objective of this study was to evaluate the diagnostic value of serum ACE levels in the diagnosis of pediatric sarcoid uveitis., Methods: This was an observational retrospective multicenter study of chronic, severe pediatric uveitis between 2013 and 2019 in two French tertiary referral centers., Results: An ACE assay result was available for 105 patients. Nine patients were diagnosed with sarcoid uveitis. The diagnostic values were as follows: sensitivity=22.2%, specificity=87.5%, positive predictive value=14.3%, negative predictive value=92.3%, positive likelihood ratio=1.8, and negative likelihood ratio=0.9., Conclusion: The diagnostic performance of ACE in pediatric sarcoid uveitis was found to be poor. NPV exceeded 90% but was based on a significant number of false negatives, indicating a high risk of misdiagnosis. Likelihood ratios confirmed the limited diagnostic value of ACE. Considering age groups and clinical manifestations may enhance precision but requires larger studies. Serum ACE used as a diagnostic marker in pediatric sarcoid uveitis warrants caution and should be interpreted alongside other factors., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Whipple's disease is a rare disease linked to chronic infection with the intracellular gram-positive bacterium, Tropheryma whipplei. The clinical signs suggestive of this disease are the association of unexplained fever, lymphadenopathy, gastroenterological disorders (malabsorption) and inflammatory joint disorders (arthritis). However, isolated cardiological, neurological or ophthalmological forms have been described. We report the rare case of a 56-year-old patient complaining of floaters and recent visual loss, who presented with bilateral panuveitis in the absence of any systemic disorder. Clinical examination showed inflammation of the anterior segment, vitritis, inflammatory optic disc edema, focal retinitis, and venous vasculitis in both eyes. We describe the clinical characteristics and ancillary findings of the disease (fundus photos, visual field, auto-fluorescence, macular OCT, fluorescein and indocyanine green angiography). The diagnosis was made with the blood (T. whipplei) PCR test and with the help of accessory salivary gland biopsies. We describe the work-up leading to the diagnosis of Whipple's disease, the laboratory tests, and the recommended extended work-up. The patient's course was marked by complete resolution of the symptoms and clinical signs within a few months following corticosteroid therapy (1mg/kg/day) combined with hydroxychloroquine (600mg per day for 1 year) and life-long doxycycline therapy (200mg per day). In conclusion, this is a rare disease which should be discussed when dealing with steroid-resistant and/or steroid-dependent chronic uveitis with a negative work-up (especially in the presence of joint and/or digestive involvement)., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Objective: To determine the incidence and outcomes of uveitis following coronavirus (COVID-19) vaccination in the pediatric population., Methods: A case series of all patients under the age of 18years diagnosed with uveitis within 28days of COVID-19 vaccination., Results: Out of 33 patients under the age of 18years who presented with uveitis from July 2021 until May 2022, eight (24.2%) developed uveitis following COVID-19 vaccination within 28days. Four had a previous history of uveitis. The mean time interval from COVID-19 vaccination to uveitis diagnosis was 14.75days. The most common anatomic diagnosis was anterior uveitis in four children, followed by panuveitis in two and posterior uveitis in two. Seven children were treated with systemic steroids/immunomodulatory agents. Improved or unaffected visual acuity was noted in all children at the final follow-up., Conclusion: The pediatric population may demonstrate uveitis following COVID-19 vaccination. All children were treated successfully, and good final visual acuity was achieved., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

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• Cette étude évalue l'apparition de l'uvéite dans la SpA axiale précoce sur 5 ans de suivi. • Un taux d'incidence estimé à 1,3/100 p-a. • L'uvéite est associée à la dactylite et à l'inflammation dans cette population. L'uvéite est une manifestation extra-rhumatologique fréquente dans la spondyloarthrite axiale (SpA). L'objectif de l'étude était d'évaluer la prévalence et l'incidence de l'uvéite au cours des cinq premières années d'une cohorte nationale prospective de patients présentant une forte suspicion de SpA axiale précoce, et d'évaluer les facteurs associés. DESIR est une cohorte d'observation prospective de patients présentant des douleurs rachidiennes inflammatoires d'apparition récente (plus de 3 mois, moins de 3 ans), suggérant une SpA axiale. Tous les facteurs disponibles dans la base de données ont été comparés entre les patients avec et sans uvéite à 5 ans, par analyse uni puis multivariée. Les facteurs de base associés aux nouveaux cas d'apparition d'uvéite au cours des 5 ans ont également été analysés. Signification : p inférieur à 0,05. Après 5 ans, 91 patients (sur 480 avec un suivi complet) ont eu au moins un épisode d'uvéite, ce qui donne une prévalence estimée à 18,9 % [95 % CI : 15,4–22,4]. Dans l'analyse multivariée, l'uvéite a été associée de manière significative à une dactylite et à une VS élevée. De nouveaux cas d'uvéite sont apparus dans 31 cas sur 5 ans, ce qui donne un taux d'incidence estimé à 1,29 [0,84–1,74]/100 patient-années. L'incidence des nouvelles uvéites a été associée dans l'analyse multivariée à des facteurs de base : diagnostic de SpA, score SPARCC inflammatoire de l'IRM sacro-iliaque, dactylite, score de syndesmophyte. Aucune association significative n'a été trouvée avec HLA-B27, l'utilisation de DMARDs, BASDAI, ASDAS, BASFI. Les données sur cinq ans de la cohorte DESIR ont permis d'estimer le taux d'incidence de l'uvéite à 1,3/100 patient-années ; sur cinq ans, l'uvéite a été associée à une dactylite, à une inflammation biologique et sacro-iliaque par IRM. [ABSTRACT FROM AUTHOR]

RESUMO A toxoplasmose ocular pode se manifestar de forma atípica, rara, bilateral e associada à necrose retiniana aguda. É apresentada em pacientes imunossuprimidos, resultando em grave perda visual, se não for solucionada rapidamente. Relata-se um caso atípico de toxoplasmose ocular em paciente diabético, que, em sua internação prévia, já evidenciava aspecto sistêmico, o qual foi elucidado pelo exame clínico oftalmológico e pela anamnese. Além disso, a rotina do setor de uveítes, ao solicitar as sorologias de forma direcionada e criteriosa, foi imprescindível para o diagnóstico da toxoplasmose sistêmica associado à lesão ocular atípica bilateral, mimetizando necrose retiniana aguda com desfecho favorável.

Objective: To screen pregnant women with positive serological results for toxoplasmosis using noninvasive, ultra-wide field retinal imaging. Methods: Prospective, descriptive longitudinal study including pregnant women with positive serological results for toxoplasmosis seen at three maternal care reference units located in Belém (PA), in the Brazilian Amazon. Patient data were collected via interview. Comprehensive eye examination, including best corrected visual acuity, biomicroscopy, tonometry and ultra-wide field imaging, was performed every three months. Results: The sample comprised 36 pregnant women. Of these, 52% had a serological profile consistent with acute toxoplasmosis, whereas 48% had a serological profile consistent with immunity. Three pregnant women had signs of chorioretinitis on ultra-wide field imaging in the first trimester. An active lesion adjacent to a scarred lesion was detected in one patient. Only women with serological results consistent with acute toxoplasmosis were treated. Treatment with systemic corticosteroids was limited to the patient with active ocular lesion. Follow-up assessment revealed resolution of the ocular lesion and normalization of visual acuity (20/20). All newborns were examined. No signs of congenital toxoplasmosis were found. Conclusion: Ophthalmological screening of pregnant women with positive serological results for toxoplasmosis should be standardized to prevent vision loss in newborns and mothers. Ultra-wide field retinal imaging can be used as an initial screening strategy to support referral for specialized care, particularly in areas with limited access ophthalmology services. [ABSTRACT FROM AUTHOR]

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The objective is to report ependymoma associated with uveitis in a four-month-old male boxer crossbreed. The dog initially presented in both eyes conjunctival hyperemia, blepharospasm, projection of the nictitating membrane, and photophobia, characteristic of uveitis. Traumatic uveitis was rejected. Six days after onset of ophthalmic symptoms, vomiting, incoordination, and behavior changes occurred. Neurological symptoms and eyebrow contraction suggesting head pain and brain injury were investigated by computed tomography (CT) nine days after, when the dog showed spasms of the limbs and neck followed by respiratory arrest with reversal and stabilization. The scans revealed extensive amorphic neoformation in the diencephalon, midbrain, and within the right lateral ventricle, along with sinistral displacement of the cerebral sickle. The animal was euthanized, and necropsy of the head revealed hydrocephalus and an intracerebral tumor mass consistent with the CT imaging. Histopathological evaluation by hematoxylin and eosin staining revealed tissue alterations in several CNS segments, showing several pseudorosettes in the neuropil, mitosis, and a high degree of cell atypia, indicating ependymoma. Inflammatory, hemorrhagic, and necrotic tissue lesions were observed in the brainstem and cerebellum due to compression by tumor tissue and hydrocephalus. The neoplasia was phenotyped by Immunohistochemistry (IHC), and tested positive for the tumoral markers vimentin and glial fibrillary acid protein, confirming intracranial anaplastic ependymoma. Behavior changes and neurological signs resulted from vascular, inflammatory, and degenerative processes in the neuropil caused by neoplasm compression and invasion of brain tissue. Although dogs with ependymoma often present with neurological disease, in the present case, blepharospasm was the first symptom noticed by the owner, and it persisted until euthanasia. According to the literature, and confirmed in the evolution of the current case, the symptoms are related to tumor location and extent and to secondary lesions due to tumor expansion. Clinical symptomatology and complementary laboratory testing, CT, necropsy, histology, and IHC characterized ependymoma, a rare condition in young dogs. [ABSTRACT FROM AUTHOR]

Brazilian equine culture is a significant activity, with a density of 0.65 horses per square kilometer. Among the main causes of damage to equine culture, eye diseases stand out, especially keratitis and uveitis. These have an inflammatory origin and are associated with the main cases of blindness in horses. In January 2019, a six-month-old male, Quarter Horse breed, bay yellow coat, was seen. The animal came from Fazenda Onça, located in the municipality of Mata Grande, 273 km from Maceió, Alagoas. In the present report, several tests, such as fluorescein tests, were carried out in order to differentiate the ERU from other causes of uveitis, as well as other primary corneal changes, since the treatment is based on the administration of corticosteroids, which do not should be instilled in cases of corneal ulcer, as it makes healing difficult. It was possible to conclude that the treatment for uveitis, carried out with an association between the topical use of anti-inflammatory, antibiotic and lubricant eye drops and systemic therapy based on anti-inflammatories, following a disciplined administration protocol, respecting the dose and schedule of each medication. [ABSTRACT FROM AUTHOR]

Les infections virales peuvent toucher l'ensemble des tuniques oculaires et mettre en jeu la fonction visuelle à plus ou moins courte terme. Les kératites et kérato-uvéites liées au virus HSV-1 sont les atteintes les plus fréquentes. Les récurrences entraînent une opacification cornéenne irréversible qui en fait la première cause de cécité d'origine infectieuse dans les pays occidentaux, et justifient un traitement antiviral préventif au long cours. Le zona ophtalmique (10 à 20 % des zonas), peut s'accompagner d'atteintes oculaires sévères (kératites, kérato-uvéites), dont 30 % deviennent chroniques/récurrentes, et de douleurs post-zostériennes, redoutables dans le territoire trigéminé. Les rétinites nécrosantes liées aux herpesvirus (HSV, VZV, CMV), sont rares mais constituent des urgences fonctionnelles absolues nécessitant un traitement antiviral par voie intraveineuse et intravitréenne. Les conjonctivites à adénovirus constituent la première cause de conjonctivite infectieuse. Le plus souvent bénignes, elles sont extrêmement contagieuses et peuvent se compliquer de lésions cornéennes invalidantes persistant plusieurs mois, voire années. Certaines arboviroses s'accompagnent de manifestations oculaires inflammatoires. Dans le cas du Zika, les infections congénitales peuvent se compliquer d'atrophie maculaire et/ou optique. Les conjonctivites sont très fréquentes à la phase aiguë de la maladie à virus Ebola, dont 15 % des survivants présentent des atteintes inflammatoires chroniques sévères liées à la persistance du virus dans les tissus uvéaux. Enfin, dans le cadre de la COVID-19, les conjonctivites ne sont pas très fréquentes mais peuvent être inaugurales, voire au premier plan et sont associées à une excrétion virale lacrymale qui doit faire prendre toutes les précautions. Viral infections may involve all ocular tissues and may have short and long-term sight-threatening consequences. Among them, ocular infections caused by herpesviruses are the most frequent. HSV-1 keratitis and kerato-uveitis affect approximately are the leading cause of infectious blindness in the Western world, mainly because of corneal opacification caused by recurrences. For this reason, they may warrant long-term antiviral prophylaxis. Herpes zoster ophthalmicus , accounts for 10 to 20% of all shingles locations and can be associated with severe ocular involvement (keratitis, kerato-uveitis) of which a quarter becomes chronic/recurrent. Post herpetic neuralgias in the trigeminal territory can be particularly debilitating. Necrotizing retinitis caused by herpesviruses (HSV, VZV, CMV) are seldom, but must be considered as absolute visual emergencies, requiring urgent intravenous and intravitreal antiviral treatment. Clinical pictures depend on the immune status of the host. Adenovirus are the most frequent cause of infectious conjunctivitis. These most often benign infections are highly contagious and may be complicated by visually disabling corneal lesions that may last over months or years. Some arboviruses may be associated with inflammatory ocular manifestations. Among them, congenital Zika infections may cause macular or optic atrophy. Conjunctivitis is frequent during the acute phase of Ebola virus disease. Up to 15% of survivors present with severe chronic inflammatory ocular conditions caused by viral persistence in uveal tissues. Finally, COVID-19-associated conjunctivitis can precede systemic disease, or even be the unique manifestation of the disease. Utmost caution must be taken because of viral shedding in tears. [ABSTRACT FROM AUTHOR]

Vogt-Koyanagi-Harada (VKH) syndrome is an inflammatory condition of unknown etiology that can affect the eye. The most common ocular manifestation related to VKH is bilateral diffuse uveitis associated to exudative retinal detachment. Although these patients respond well to steroid pulse therapy, we report a case of a 44-year-old female patient presenting bilateral exudative retinal detachment and clinical diagnosis of VKH, who did not respond to the first cycle of 3-day pulse therapy with methylprednisolone. The exudation was reabsorbed only after a second cycle of steroid therapy. [ABSTRACT FROM AUTHOR]

Le diagnostic de tuberculose oculaire (TO) demeure difficile et la contribution du QuantiFERON® (QFT) reste à préciser malgré sa généralisation en France. L'objectif de cette étude est d'évaluer dans quelles situations d'inflammation oculaire (IO) le QFT doit être prescrit et l'intérêt du nouveau test QuantiFERON®-TB-Plus (QFT-Plus) dans la TO. Étude monocentrique, observationnelle, effectuée en ophtalmologie sur une période de 5 mois. Les critères d'inclusion étaient l'existence d'une IO avec QFT-Plus demandé à visée étiologique. Sur 316 dossiers consécutifs, 72 ont été exclus (tests indéterminés, bilan préthérapeutique, données manquantes et mauvaise indication) et 244 retenus et répartis en deux groupes : groupe 1 (uvéite antérieure/épislérite, n = 129), groupe 2 (uvéite intermédiaire/postérieure/névrite optique/myosite oculaire, n = 115). Tous les patients QFT+ ont bénéficié d'un bilan étiologique avec imagerie thoracique. Quarante-cinq patients, d'âge médian de 52 ± 12 ans, avaient un QFT+ (18,5 %), incluant 18 patients dans le groupe 1 et 27 dans le groupe 2. Un voyage en pays d'endémie et un contage tuberculeux et des anomalies de l'imagerie thoracique étaient identifiés, respectivement dans 70 %, 27 % et 22 % des cas. L'IO était chronique chez 36 % des patients (groupe 1, n = 4/18 ; groupe 2, n = 12/27). Aucun des 18 patients du groupe 1, n'a reçu de quadrithérapie antituberculeuse, ni n'a présenté de rechute à 1 an de suivi. Un diagnostic alterne était retrouvé chez 15 % des patients du groupe 2. Parmi les 23 patients, sans étiologie identifiée, 13 (59 %) avaient au moins un élément sémiologique ophtalmologique prédictif de TO (synéchies postérieures, vascularite rétinienne, granulomes choroïdiens). Onze patients ont bénéficié d'un traitement antituberculeux (TAT) d'épreuve (rifampicine/isoniazide/pirilène/éthambutol) de six mois. La présence de granulomes à l'angiographie et d'anomalies radiologiques à l'imagerie thoracique était statistiquement plus fréquente parmi les patients ayant reçu un TAT (respectivement, p = 0,001 et 0,03). Une guérison à 12 mois était observée pour 8 patients (73 %), considéré a posteriori comme TO. Neuf patients ont reçu trois mois de bithérapie (rifampicine/isoniazide) sans que l'on puisse déterminer l'impact sur l'IO. La comparaison des réponses lymphocytaires T entre la stimulation CD4 par peptides ESAT-6/CFP-10 ou la co-stimulation CD4/CD8 était similaire, ne retrouvant que 4 discordances sur 244 tests (1,5 %). Aucun de ces 4 patients n'avait de TO. La fréquence de positivité du QFT est élevée parmi les patients consultant pour une IO postérieure. Les anomalies radiologiques et la présence de granulomes semblent être les éléments qui ont incités le clinicien à initier un TAT aux patients QFT+, avec guérison dans 73 % des cas. Le QFT-Plus ne semble pas plus pertinent que le QFT-TB-Gold dans l'exploration d'une IO. Des études prospectives restent nécessaires pour codifier l'utilisation du QFT dans le bilan étiologique des IO et définir les indications du TAT d'épreuve et de ses modalités. Ocular tuberculosis (TB) diagnosisremains difficult and quantiferon (QFT) contribution needs still yet to be specified, despite its generalization in France. The purpose of this observational study is to assess in which ocular inflammation (OI) presentation QFT is prescribed and to evaluate the added value of new QuantiFERON®-TB Gold Plus (QFT-Plus) test for diagnosis ocular TB diagnosis. Monocentric, observational study, carried out in an ophthalmology department over a period of 5 months. Inclusion criteria were defined as an existence of an OI for which a QFT-Plus test was part of the etiological investigations. Of the 316 consecutive files, 72 were excluded (indeterminate test, prescription before anti-TNFα or immunosuppressant initiation, missing data, wrong indication) and 244 were selected and divided into two groups: group one (anterior uveitis/episcleritis, n = 129) and group two (intermediate/posterior uveitis/optic neuritis/ocular myositis, n = 115). All positive QFT patients underwent an etiological investigation including thoracic imaging. Forty-five patients, aged 52 ± 12 years, had positive QFT (18.5%), including 18 patients for group 1 and 27 for group 2. Living in TB-endemic area, TB exposure and chest imaging abnormalities were identified in 70%, 27% and 22% of cases, respectively. OI was chronic in 36% of cases (group one, 4/18; group two, 12/27). None of the 18 patients, in group 1, received anti-tuberculosis treatment (ATT) or experienced a relapse during one-year follow-up. Four QFT+ patients, from group 2 (15%) had another associated disease explaining their uveitis. Among the 23 other patients without identified etiology, 13 had at least one relevant ophthalmological signs predictive of TB uveitis (posterior synechiae, retinal vasculitis and/or choroidal granuloma) (59%). Eleven patients received a 6-month ATT trial. Radiological abnormalities and granulomas at angiography were significantly more frequent among treated patients (p = 0.03 and 0.001, respectively). A full OI recovery was observed for 8 patients (73%), considered ex-post as ocular TB. Nine patients in group 2 received rifampicin/isoniazid dual therapy for 3 months, but no conclusion could be drawn as to the benefit of such prescription on OI. QFT rate comparison, according to CD4 stimulation by ESAT-6/CFP-10 peptides or by CD4/CD8 co-stimulation, was comparable and found only 4 cases of discrepancy (1.6%). None of these 4 cases had ocular TB diagnosis. Positive QFT frequency among patients consulting for posterior OI remains high. In this study, radiological abnormalities and granulomas at angiography seemed to be more closely related to clinician decision for starting ATT trial in QFT+ patients, which was effective in 73% of cases. QFT-Plus does not seem more relevant than QFT-TB in exploring an OI. Prospective studies are necessary to codify QFT management in the etiological assessment of OI and clearly define ATT trial indications as well as their modalities. [ABSTRACT FROM AUTHOR]

RESUMO A síndrome de Vogt-Koyanagi-Harada (SVKH) é rara, multissistêmica e autoimune. Atinge principalmente os olhos, provocando uma panuveíte crônica bilateral, porém traz afecções em outras áreas e tecidos que são ricos em melanócitos, como olhos, orelha interna, meninges e a pele. Sua origem ainda não é totalmente conhecida. Geralmente, a SVKH atinge indivíduos de origem hispânica, do Oriente Médio, indianos, nativos americanos e asiáticos. Descrição dos aspectos audiológicos acometidos pela síndrome e as possíveis intervenções fonoaudiológicas para um caso específico. Paciente de 53 anos, sexo feminino, compareceu à Clínica de Fonoaudiologia, Faculdade de Odontologia de Bauru (FOB) com queixas audiológicas e diagnóstico médico da SVKH. A paciente apresentou perda auditiva sensório-neural bilateralmente, emissões otoacústicas evocadas ausentes e queixas vestibulares de vertigem postural e desequilíbrio ao andar, bem como queixa de zumbido agudo contínuo. O caso apresentado mostrou perda auditiva sensório-neural, vertigem, zumbido e acometimento ocular bilateral. Apesar do tratamento com corticoesteroide, a perda auditiva se manteve. Desta forma, precedente à indicação do AASI, o fonoaudiólogo deve atentar-se para o acompanhamento audiológico do caso, realização ou não de tratamento medicamentoso e ocorrência de sintomas sugestivos da síndrome, favorecendo o encaminhamento para o médico e participando ativamente do processo terapêutico envolvendo a audição.

Les atteintes ophtalmologiques au cours de la SPA sont présentes dans 35 % à 50 % des cas. Ceci correspond essentiellement à une uvéite antérieure. Par ailleurs l´atteinte du segment postérieur est une atteinte rare reportée dans certaines publications. Nous rapportons le cas d´un patient âgé de 26 ans ayant comme antécédents une des lombalgies inflammatoires, qui se présente pour une uvéite totale avec vascularite occlusive bilatérale compliquée d´hémorragie intra vitréenne; un bilan étiologique a été réalisé ayant éliminé une cause infectieuse ou autre de sa vascularite, une IRM sacro-iliaque a mis en évidence un hypersignal sacro-iliaque; le diagnostic de vascularite rétinienne secondaire à la spondylarthrite ankylosante a été retenu. Nous avons rapporté un cas rare d´uvéite postérieure avec une vascularite au cours de la spondylarthrite ankylosante, ceci devrait nous inciter à chercher les atteintes du segment postérieur au cours de la SPA et éventuellement ne pas réfuter le diagnostic en cas de telles manifestations.

Introduction: Uveitis in children is rare. Their insidious character involves visual prognosis and can lead to blindness. They require rapid treatment to avoid sequelae and preserve visual function. Our aim was to describe the epidemiological, etiological, clinical, therapeutic and evolutionary features of uveitis in children. Methods: This was a retrospective study made of 38 patients (43 eyes) diagnosed with uveitis. Epidemiological, clinical and therapeutic characteristics were analyzed retrospectively. Results: Thirty eight patients (43 eyes) were included, among them 23 boys and 15 girls. The mean age at presentation was 12.58 3.046 years. Uveitis was bilateral in 13% of cases. The median time between onset of visual symptoms and consultation was 6 days with extremes of one to 15 days. Posterior uveitis (40%) and panuveitis (30%) were the most common anatomic types of uveitis. We found a majority of toxoplasmic and idiopathic uveitis respectively in 25% and 18% of cases. Systemic corticosteroids were administered in 32 patients. Three children among them were treated with azathioprine. The follow-up ranges between 1 and 72 months. The recurrence was observed in Behçet's disease and Vogt-Koyanagi-Harada disease. The final visual acuity of patients followed was greater than 5/10 in 54%, between 1/10 and 5/10 in 18% and less than 1/10 in 28%. Legal blindness was noted in 9% of the eyes. Conclusion: The diagnosis of uveitis in children represents a real etiological, diagnostic and therapeutic challenge requiring close collaboration with the pediatrician and the internist. [ABSTRACT FROM AUTHOR]

• Différents sous-types d'AJI sont associés à des fréquences variables d'uvéite. • Parmi les maladies rhumatismales juvéniles, la fréquence de l'uvéite est la plus élevée dans la maladie de Behçet juvénile, suivie de l'AJI (sous-type oligoarthrite). • La fréquence de l'atteinte oculaire dans les maladies rhumatismales juvéniles varie selon la région géographique. Cette méta-analyse a étudié la fréquence et le type des atteintes oculaires dans les arthrites inflammatoires et d'autres maladies rhumatismales juvéniles. Nous avons recherché les publications relatives aux arthrites et maladies rhumatismales juvéniles décrivant la fréquence de l'uvéite dans un contexte de rhumatisme juvénile et incluant au moins 20 patients dans les bases de données Medline, Web of Science et Cochrane, entre leur date de création et septembre 2018. La prévalence et le type des complications oculaires ont été extraits et leur fréquence a été estimée par des modèles à effets aléatoires. L'hétérogénéité a été évaluée au moyen du test I2. Un total de 59 articles résultant de 7132 citations uniques ont été inclus. La fréquence compilée de l'uvéite était de 24 % dans l'AJI oligoarticulaire, 12 % dans l'AJI polyarticulaire, 1 % dans l'AJI systémique, 50 % dans la maladie de Behçet (MB) juvénile, 9 % dans le rhumatisme psoriasique (RPso) juvénile, 24 % dans la spondyloarthropathie (SpA) juvénile et 5 % dans le lupus érythémateux systémique (LES) juvénile. Le type d'uvéite le plus fréquent dans l'AJI était l'uvéite antérieure, observée dans 14 % des cas et décrite comme une iridocyclite chez 10 % des patients. Le biais de publication était négligeable pour toutes les affections à l'exception de celles ayant été peu étudiées (LES juvénile et AJI systémique). L'uvéite dans l'AJI était plus fréquente en Europe (14 %), en Amérique du Nord (11 %) et au Moyen-Orient (12 %) qu'en Asie de l'Est (7 %) et en Océanie (3 %). L'atteinte oculaire (essentiellement uvéite) dans l'arthrite inflammatoire juvénile et d'autres rhumatismes pédiatriques variait de 3 à 50 % selon l'affection sous-jacente et était la plus fréquente dans la maladie de Behçet de l'enfant. Parmi les AJI, la fréquence de l'uvéite la plus élevée a été constatée dans l'AJI oligoarticulaire et l'uvéite antérieure était le type le plus fréquent. Des variations géographiques ont été observées pour l'uvéite dans l'AJI. [ABSTRACT FROM AUTHOR]

Canine uveodermatologic syndrome is an autoimmune disease that leads to the appearance of ophthalmic and dermatological signs, such as bilateral panuveitis, vitiligo, leukotrichia, alopecia and ulcerations. Due to the lack of information about the uveodermatologic syndrome, the objective of this work is to carry out a systematic review on the main aspects of the disease, alerting the veterinarian about its occurrence and the importance of its early diagnosis. Despite the rare reports within the small animal clinic, it is believed that dogs of the Akita breed may be predisposed by the number of reported cases, although there are several records with other breeds in the literature. The diagnosis is usually late, due to the fact that the eye lesions appear about a month before the cutaneous lesions, and involves the clinical reasoning of the veterinarian in association with the performance of histopathological exams of the lesions, which present inflammatory histio-lymphocitic infiltrates and disorganization of basal layer. The treatment is based on immunosuppression, with corticosteroids or other similar drugs, such as azathioprine and cyclosporine, continuing from the diagnosis until the disappearance of clinical signs and maintenance at low doses or in association with other immunomodulators. [ABSTRACT FROM AUTHOR]

We present a case of neurosyphilis in a young man with a complaint of low visual acuity in the left eye. He had erythematous-scaly lesions on the palms of the hands, soles of the feet and oral ulcers, without genital lesions. The ophthalmic examination revealed arteritis in the upper nasal arcade in the affected eye. He presented VDRL (1: 4096) and FTA-Abs positive. The cerebrospinal fluid cerebrospinal fluid test was negative. The treatment was performed with ceftriaxone 2g/day for 14 days, associated with prednisone 0.5mg/kg oral 48h after antibiotic onset. After 15 days of treatment, there was improvement of AV, regression of vasculitis and reduction of VDRL titration to 1: 128. [ABSTRACT FROM AUTHOR]

Objective: To evaluate and compare characteristics, diagnosis, treatment, visual prognosis, and course between ocular sarcoidosis with or without uveitis in a population in Southern France., Methods: We retrospectively analyzed data from patients with ocular sarcoidosis in a tertiary eye care center in Nice from January 2003 to December 2021. The inclusion criterion was biopsy-proven ocular sarcoidosis according to IWOS criteria as the first clinical manifestation of sarcoidosis., Results: A total of 25 patients were included. Twenty patients had uveitis (70% panuveitis, 20% intermediate uveitis, and 10% anterior uveitis) and five patients had non-uveitic ocular sarcoidosis (one patient with dacryoadenitis, one patient with orbital granuloma, two patients with palpebral granuloma, and one patient with episcleritis). Only the cases with uveitis had bilateral involvement (85% of cases). There was no significant difference in ethnicity, biopsy diagnosis, systemic manifestations, or treatment between the two groups. Final visual outcomes remained good for both groups, with 96% of patients with BCVA>20/50, with no significant difference. Patients with non-uveitic sarcoidosis experienced less recurrence on treatment (P=0.042) and more remission (P=0.038) than patients with uveitis. Eighty percent of patients with uveitis had at least three suggestive clinical intraocular signs meeting IWOS criteria., Conclusion: In this population in Southern France, uveitis was the most common presentation of ocular sarcoidosis. The type of ocular sarcoidosis does not appear to be correlated with the type of systemic manifestations, use of systemic therapy, or visual prognosis, but patients with non-uveitic ocular sarcoidosis appear to have a better course with fewer recurrences on treatment and more remission than patients with uveitic ocular sarcoidosis., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Résumé: Les manifestations extra-intestinales des maladies inflammatoires chroniques de l'intestin (MICI) sont fréquentes et polymorphes, dominées par les atteintes ostéoarticulaires et cutanéo-muqueuses. Ces manifestations ont un impact significatif sur la qualité de vie des patients et sur les choix thérapeutiques du clinicien. Les manifestations extra-intestinales associées aux MICI surviennent de façon plus fréquente au cours de la maladie de Crohn par rapport à la rectocolite hémorragique. La plupart des manifestations extradigestives évoluent de façon synchrone avec l'activité de la MICI. Un certain nombre peut néanmoins évoluer de façon dissociée, nécessitant des prises en charge concomitantes. Cette distinction souligne la physiopathologie complexe de ces manifestations qui peuvent faire intervenir d'un côté le déclenchement d'une réponse immunitaire au-delà du tube digestif via une translocation d'épitopes bactériens et de l'autre, une communauté de facteurs génétiques et environnementaux partagés par différentes entités inflammatoires. Dans cette revue, nous aborderons les aspects cliniques des manifestations extra-intestinales et ses conséquences sur la prise en charge des MICI. Patients with Inflammatory Bowel Disease (IBD) experience at least one extra-intestinal manifestation (EIM) in up to 50% of the cases. EIM have a negative impact on the patient's quality of life and may interfere with treatment decision-making. EIMs are more common in CD than UC and there is a broad range of manifestations. The most prevalent EIMs in IBD are arthralgia/arthritis and skin manifestations. Most EIMs run in parallel with the intestinal disease activity but they may also have distinct course requiring multidisciplinary management. The pathogenesis of EIM in IBD is not univocal, combining a trigger immune response at the extraintestinal site due to translocation of bacterial epitopes and a shared community of genetic and environmental factors. This review focuses on the clinical features of EIM and consequences on the management of patients with IBD. [ABSTRACT FROM AUTHOR]

Different cytokines are believed to play an important role in the pathogenesis of juvenile idiopathic arthritis (JIA). Some of them may serve as the prognostic markers for the disease severity, the eye lesion, and the effectiveness of therapy in JIA patients. To evaluate the serum concentration of TNFα, IL1β, IL6 and IL10, their spontaneous and mitogen-induced production levels in the whole blood cell culture of JIA patients and to correlate these indicators with the disease features and with the effectiveness of methotrexate therapy. Twenty-eight Russian patients with JIA, naive for disease-modifying antirheumatic drugs, were enrolled in the study. The serum levels of cytokines (TNFα, IL1β, IL6, and IL10); the levels of their spontaneous and mitogen-induced production in the whole blood cell culture were studied by solid-phase enzyme immunoassay. The serum levels and spontaneous production levels of TNFα, IL1β, IL10 were low in JIA patients. The levels of TNFα, IL1β, IL6, IL10 in mitogen-induced production were significantly higher than those in spontaneous production (pcor<0,05). The association of some clinical features (disease duration, uveitis, elevated ESR, hyperimmunoglobulinemia M with the cytokines (TNFα, IL6, and IL10) levels was established in JIA. The most promising is the association between the uveitis in JIA patients and an increase of spontaneous IL6 production (pcor=0,004), as well as a decrease of mitogen-induced TNFα production (pcor=0,029) in the whole blood cell culture. Statistically significant associations with a response to methotrexate therapy and disease severity in JIA patients were not observed. As a result of studying levels of cytokines (TNFα, IL1β, IL6, and IL10) in JIA patients, the relationship of TNFα, IL6 and IL10 was established with the number of clinical manifestations of the disease. If confirmed in larger samples, the study of the spontaneous IL6 production in the whole blood cell culture might be used for the early diagnosis of the uveitis in JIA patients. [ABSTRACT FROM AUTHOR]

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Objective: Herpes Zoster Ophthalmicus (HZO) is caused by varicella-zoster virus (VZV) and commonly affects elderly or immunocompromised patients. It has the potential to generate severe complications such as corneal ulcers, uveitis, retinal necrosis and post herpetic neuralgia. This study aimed to evaluate patients at the acute onset of the disease and describe their clinical profile and ophthalmologic findings. Methods: A cross-sectional study was performed from March 2014 to October 2015. All consecutive patients with the diagnosis of acute HZO (at a vesicle, pustule or crust stage) were enrolled and submitted to an ophthalmologic exam that included ectoscopy, best corrected visual acuity, corneal sensitivity test, slit-lamp examination, Goldmann applanation tonometry and funduscopic examination. Results: Nineteen patients were included. The mean age was 71 years old, ranging from 52 to 88. Ten patients had high blood pressure (52.6%) and nine (47.3%) had diabetes. Visual acuity lowered in comparison to the fellow eye in eleven patients (57%), ranging from one to six lines of vision, due mostly to epithelial keratitis and ocular discharge. Intraocular pressure (IOP) did not varied in most cases compared to the fellow eye. Hutchinson’s sign (HS) was present in seven (36%) patients. The correlation between HS and anterior chamber reaction as well as decreased corneal sensitivity was statistically significant with Fisher’s test of 0.009 and 0.029 respectively (p<0.05). Conclusion: The clinical profile of our patients was elderly patients with a higher rate of diabetes. Correlation between Hutchinson’s sign and anterior chamber reaction as well as decrease in corneal sensitivity was significant. High intraocular pressure or posterior segment complications were not found in any cases. [ABSTRACT FROM AUTHOR]

Copyright of Acta Veterinaria Brasilica is the property of Acta Veterinaria Brasilica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Resumo Introdução: A síndrome nefrite tubulointersticial e uveíte (síndrome TINU) é uma entidade clínica incomum e a maioria dos pacientes são adolescentes e mulheres jovens. O caso relatado a seguir refere-se a uma paciente idosa com manifestações oftalmológicas que antecederam às renais, sendo provavelmente o primeiro caso descrito no Brasil. Relato de Caso: Paciente feminina, 60 anos, procurou atendimento médico por queixa de "olhos vermelhos". Três meses após o primeiro episódio do quadro ocular, a paciente cursou com sintomas sistêmicos e disfunção renal. A biópsia renal evidenciou nefrite tubulointersticial com sinais de atividade. Discussão: A fisiopatologia da síndrome TINU permanece pouco entendida, provavelmente envolvendo a imunidade celular e humoral. Essa síndrome pode ser diferenciada de condições sistêmicas associadas à uveíte e à nefrite, sendo necessária a exclusão de outras doenças antes de se confirmar seu diagnóstico, especialmente na presença de achados oftalmológicos. Conclusão: A suspeição clínica e o conhecimento do manejo desta patologia por nefrologistas, internistas e oftalmologistas são mandatórios no tratamento do paciente com Síndrome TINU.

Cogan's syndrome is a rare autoimmune inflammatory disease, characterized by interstitial keratitis and audio-vestibular signs. The syndrome was first described in 1945 by David G. Cogan. Then, it was only in 1980 when Haynes et al. proposed diagnostic criteria for patients with other symptoms and was qualified as atypical form of Cogan's syndrome. Herein, we report a case of a 28-year-old woman with atypical Cogan's syndrome. The patient was treated with corticosteroids and received a cochlear implant., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Copyright of Revista de Medicina e Saúde de Brasília is the property of Revista de Medicina e Saude de Brasilia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé Objectifs Évaluer la fréquence de survenue des réactions paradoxales chez les patients présentant une polyarthrite rhumatoïde sous tocilizumab, à l'aide du registre REGATE (Registry-RoActemra). Les objectifs secondaires étaient de déterminer le type de réaction paradoxale et les conséquences de ces réactions. Méthodes Le registre REGATE est un registre observationnel prospectif multicentrique, promu par la Société française de rhumatologie, composé de patients traités par tocilizumab pour une polyarthrite rhumatoïde. Nous retenions le diagnostic de réaction paradoxale s'il s'agissait d'une pathologie pour laquelle le tocilizumab était indiqué, si le tocilizumab était utilisé pour une autre indication et si la pathologie induite apparaissait après au minimum une perfusion de tocilizumab. Résultats Parmi les 1491 patients inclus avec au moins une visite de suivi (3429 patients-années), une réaction paradoxale s'est produite chez 9 patients (0,60 % des patients, 2,62/1000 patients-années). Il s'agissait de 7 pathologies de novo (3 vascularites, 3 uvéites, 1 lupus) et 2 exacerbations de pathologies préexistantes (1 vascularite, 1 lupus). Un arrêt définitif du tocilizumab a été décidé pour 5 patients. Conclusions Dans le registre REGATE, la survenue de réactions paradoxales chez les patients traités par tocilizumab était rare. [ABSTRACT FROM AUTHOR]

Résumé Introduction La démarche diagnostique au cours des uvéites n’est pas standardisée. Elle doit prendre en compte l’épidémiologie des uvéites, cibler les affections les plus sévères et/ou les plus fréquentes, et/ou susceptibles de bénéficier d’un traitement spécifique. Ce travail a été réalisé afin de proposer des recommandations pour le diagnostic des uvéites. Méthodes Les recommandations ont été établies par un groupe de 15 experts, internistes, ophtalmologistes et rhumatologues, à partir d’une revue de la littérature et de l’étude ULISSE qui est la première étude prospective à avoir évalué une stratégie diagnostique pour les uvéites. Sont exclues de ces recommandations les uvéites de l’enfant, de l’immunodéprimé, les vascularites rétiniennes sévères et les entités purement ophtalmologiques. Résultats Le bilan paraclinique doit en premier lieu être orienté par les éléments de l’interrogatoire et les signes cliniques. La sérologie syphilitique est la seule sérologie systématique. Les sérologies toxoplasmose et herpès virus seront réalisées en cas de suspicion diagnostique et avant tout prélèvement oculaire. En l’absence de cause identifiée, nous proposons un bilan paraclinique orienté par les caractéristiques de l’uvéite. Il comporte un typage HLA B27 (uvéite antérieure aiguë unilatérale non granulomateuse), un dosage de l’enzyme de conversion de l’angiotensine, un test IFN-γ release assay (IGRA) et un scanner thoracique (uvéite chronique), une IRM cérébrale associée à une ponction de chambre antérieure avec dosage de l’interleukine 10 (uvéite intermédiaire ou postérieure après 40 ans). La rentabilité d’examens complémentaires non orientés est très faible. Conclusions Nous proposons une stratégie diagnostique pour les uvéites. Les recommandations doivent être actualisées régulièrement. La place des examens les plus invasifs reste à définir. Introduction Diagnostic work-up of uveitis involves many uncertainties. Search for an etiology should take into account the epidemiology of uveitis and focus on the most severe diseases or those, which can be treated. This work was undertaken to establish recommendations for the diagnosis work-up of uveitis. Methods Recommendations were developed by a multidisciplinary panel of 15 experts, including internists, ophthalmologists and a rheumatologist and are based on a review of the literature with regard to effectiveness of investigations and the results of the ULISSE study, which is the first prospective study assessing the efficiency of a standardized strategy for the etiological diagnosis of uveitis. Children, immunocompromised patients, severe retinal vasculitis and specific ophthalmological entities are excluded from these recommendations. Results Investigations should be first guided by the history and physical examination. Serological screening for syphilis is the only test appropriate in all forms of uveitis. If no diagnosis is made after this stage, we propose investigations guided by the anatomic characteristics of uveitis. It includes HLA B27 testing (in unilateral acute anterior non-granulomatous uveitis), serum angiotensin converting enzyme, interferon-gamma release assay and chest CT (chronic uveitis), cerebral MRI and anterior chamber tap with IL10 analysis (intermediate or posterior uveitis in patients over 40 years). Investigations ordered in the absence of orientation are almost always unhelpful. Conclusions We propose a strategy for the etiologic diagnosis of uveitis. The recommendations should be updated regularly. The efficiency of more invasive investigations has yet to be evaluated. [ABSTRACT FROM AUTHOR]