Choroiditis, Pigment Epithelial Detachment, and Cystoid Macular Edema as Complications of Poststreptococcal Syndrome
Choroiditis, Pigment Epithelial Detachment, and Cystoid Macular Edema as Complications of Poststreptococcal Syndrome
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链球菌感染后综合征的并发症包括脉络膜炎、色素上皮脱离和黄斑囊样水肿
DOI：
10.1097/01.opx.0000141792.16683.91
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发表时间：
2004
影响因子：
1.4
通讯作者：
S. Schatz
中科院分区：
文献类型：
--
作者：
E. Besada;Barry J. Frauens;S. Schatz
目的报告2例链球菌感染后葡萄膜炎。1例患者发生非肉芽肿性前葡萄膜炎（病例1）。第二例患者发生非肉芽肿性前葡萄膜炎，随后发生肉芽肿性葡萄膜炎，并发脉络膜炎、视网膜色素上皮脱离和黄斑囊样水肿（病例2）。目前关于链球菌感染后综合征的发病机制及其眼部后遗症的概念也进行了讨论。病例报告病例1：一名31岁女性患者，在最近出现咽喉痛后出现双侧非肉芽肿性葡萄膜炎。在采集患者病史时，发现既往诊断为风湿热。血液化学分析表明抗链球菌溶血素O抗体滴度升高是唯一显著升高的结果。病例2：一名33岁女性，最初表现为双侧非肉芽肿性葡萄膜炎。报告了复发性咽喉痛病史。血液化学分析仅显示抗链球菌溶血素O抗体滴度升高。最终出现“羊脂”角膜沉淀物;然而，局部睫状肌麻痹剂和皮质类固醇治疗后，双侧葡萄膜炎消退。一个前肉芽肿性葡萄膜炎并发脉络膜炎，视网膜色素上皮脱离，囊样黄斑水肿在复发发作。当时血液化学分析无异常。结论.在有临床病史和/或血清学证据表明可能存在链球菌感染的患者中，前非肉芽肿性/肉芽肿性和后葡萄膜炎应被视为链球菌感染后综合征的临床表现。宿主遗传易感性免疫应答的变化、患者的人类白细胞抗原单倍型、病原体毒力和/或免疫循环复合物的沉积位置可能引起链球菌感染后综合征临床眼部后遗症的多样性。链球菌感染后葡萄膜炎可能包括与急性风湿热、急性肾小球肾炎和其它自身免疫性疾病相似的免疫发病机制。
Purpose Two cases of poststreptococcal uveitis are presented. One patient developed nongranulomatous anterior uveitis (case 1). A second patient developed nongranulomatous anterior uveitis followed by granulomatous uveitis with concurrent choroiditis, retinal pigment epithelial detachment, and cystoid macular edema (case 2). Current concepts regarding the pathogenesis of poststreptococcal syndrome and its ocular sequelae are also discussed. Case Reports Case 1: A 31-year-old female patient presented with bilateral nongranulomatous uveitis after a recent onset of sore throat. A past diagnosis of rheumatic fever was revealed during acquisition of the patient’s history. Blood chemistry analysis indicated elevated anti-streptolysin O antibody titers as the only significant elevated result. Case 2: A 33-year-old female presented initially with bilateral nongranulomatous uveitis. A history of recurrent sore throat was reported. Blood chemistry analysis revealed elevated anti-streptolysin O antibody titers only. “Mutton fat” keratic precipitates eventually developed; however, the bilateral uveitis resolved after topical cycloplegic and corticosteroid treatment. An anterior granulomatous uveitis with concurrent choroiditis, retinal pigment epithelial detachment, and cystoid macular edema ensued during a recurrent episode. Blood chemistry analysis was unremarkable at that time. Conclusions. Anterior nongranulomatous/granulomatous and posterior uveitis should be considered clinical manifestations of poststreptococcal syndrome in patients with a clinical history and/or serological evidence indicating possible past streptococcal infection. A variation of host-genetic-predisposed immune response, the patient’s human leukocyte antigen haplotype, pathogen virulence, and/or deposition location of immune circulating complexes may give rise to the diverse spectrum of clinical ocular sequelae in poststreptococcal syndrome. Poststreptococcal uveitis may comprise a similar immunologic pathogenesis to that of acute rheumatic fever, acute glomerulonephritis, and other autoimmune diseases.
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DOI：
--
发表时间：
1991
期刊：
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影响因子：
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DOI：
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发表时间：
1989
期刊：
Journal of immunology (Baltimore, Md. : 1950)
影响因子：
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影响因子：
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作者：
Fontán, PA;Pancholi, V;Fischetti, VA
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DOI：
--
发表时间：
1988
期刊：
Journal of immunology (Baltimore, Md. : 1950)
影响因子：
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作者：
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