2 research outputs found
A Unique Case of Acute Deterioration in Visual Acuity: Vogt-Koyanagi-Harada Disease
No full textVogt-Koyanagi-Harada (VKH)disease is a chronic autoimmune inflammatorydisorderwithmultisystem involvement particularly involving the eye, skin, ear and brain. Our patient reported in the Ophthalmology OPD, CMH, Lahore, a 41-year-old female patient who presented with decreased visual acuityof 6/9 and 6/18 in her right and left eye respectively with intermittent tinnitus. Aslit lamp examination revealed bilateral paramacular choroiditis, more pronounced in the left eye. Fundoscopy showed the 'sunset glow fundus.' HerOCTshowedslightflattening ofthe foveal contourinthe left eye withgeneralized foveal thinning while the right eye had parafoveal thickening with a foveal lamellar hole. FFAshowed a serous detachment in herleft eye.Adiagnosis of bilateral incomplete Vogt-Koyanagi-Haradasyndrome was made as she tested negative for infectious diseases. She was started on an oral course of steroids initially but after persistent episodic exacerbations ciclosporin 75mg twice daily was started and regular 2 weekly follow-ups were advised. The mainstay of treatment for Vogt–Koyanagi–Harada disease is systemic corticosteroid therapy but the refractory cases get additional immunosuppressants like ciclosporin which was required in our patient as well.Keywords: Autoimmune, Fovea, Visual acuity
A Case of Persistent Methicillin- Resistant Staphylococcus Aureus (MRSA) Bacteraemia with no Identifiable Source: A Peculiar Clinical Challenge
No full textWith the increase in antibiotic resistance, Methicillin-resistant Staphylococcus aureus (MRSA) hasbecome a global health challenge. We present a case of a 74-years-old female who was unwell withcomplaints of dizziness, shortness of breath on exertion and palpitations. She had presented withparoxysmal atrial fibrillation and Methicillin-Resistant Staphylococcus aureus (MRSA) bacteraemiawith concerns for possible endocarditis. Transesophageal Echocardiogram (TEE) performed ruledout any evidence of endocarditis. MRSA sepsis was established based on blood cultures with unclearsources. After 7 days on Vancomycin and Ceftaroline, her repeated blood cultures were still positivefor MRSA, so she was started on IV Cefazolin 2g and IV Daptomycin 6mg/kg every 24 hours. Herblood culture cleared after 5 days of this therapy. Treatment strategies for patients of MRSAB need tobe individualized to achieve infection clearance, while guidelines do serve to provide a basicblueprint of treatment plans for physicians.Keywords: Methicillin-Resistant Staphylococcus Aureus, Bacteremia, Sepsis
