Subretinales Granulom, retinale Vaskulitis und Keratouveitis mit sekundärem Offenwinkelglaukom bei Schistosomiasis

TY - JOUR

T1 - Subretinales Granulom, retinale Vaskulitis und Keratouveitis mit sekundärem Offenwinkelglaukom bei Schistosomiasis

AU - Bialasiewicz, A A

AU - Hassenstein, A

AU - Schaudig, U

PY - 2001/10/1

Y1 - 2001/10/1

N2 - BACKGROUND: More than 250 million people in Africa and Asia currently suffer from schistosomiasis, however, ocular manifestations of this disease are rare in Germany. PATIENT AND FOLLOW-UP: We present the case of a 32-year-old patient from Gambia who had been resident in Germany for 3 years and suffered from a painful persistent diarrhoea, fever and a reduction of visual acuity (R > L). On admission, the patient reported a schistosomiasis in 1994, which was diagnosed by a skin test and was not adequately treated because of the side-effects of praziquantel. Vision was OD-0.75 sph 0.8, OS sc 1.0, IOD OD 31, OS 18 mmHg. Biomicroscopy: R > L fatty retrocorneal precipitates, especially in the lower circumference (ARLT), large inflammatory cells and Tyndall ++, vitreous with large inflammatory cells, Fundus: OD at 11 o'clock large subretinal granuloma in the periphery. Serum lysozyme was elevated (22.2 mg/l, normal range 10-17 mg/l), a syphilis stage II-III (TPHA 1:5000, VDRL neg.) and an IgG-antibody titre for Schistosoma mansoni of > 30 micrograms/ml was detected by enzyme immunoassay. In the faeces and urine no schistosoma eggs were found. Before the specific treatment for schistosomiasis could be initiated, the patient left the hospital because of reduced ocular pain due to the corticosteroids and fear of the side-effects of the treatment.DISCUSSION: In patients who present a subretinal granuloma and report a painful persistent diarrhoea, schistosomiasis, which is one of the most frequent tropical diseases should be considered, even if they have been living in central Europe for several years. Although the disease cannot become established due to the lack of specific hosts in this area, a curative treatment should be enforced in order to prevent late manifestations of chronic inflammatory organ manifestations.

AB - BACKGROUND: More than 250 million people in Africa and Asia currently suffer from schistosomiasis, however, ocular manifestations of this disease are rare in Germany. PATIENT AND FOLLOW-UP: We present the case of a 32-year-old patient from Gambia who had been resident in Germany for 3 years and suffered from a painful persistent diarrhoea, fever and a reduction of visual acuity (R > L). On admission, the patient reported a schistosomiasis in 1994, which was diagnosed by a skin test and was not adequately treated because of the side-effects of praziquantel. Vision was OD-0.75 sph 0.8, OS sc 1.0, IOD OD 31, OS 18 mmHg. Biomicroscopy: R > L fatty retrocorneal precipitates, especially in the lower circumference (ARLT), large inflammatory cells and Tyndall ++, vitreous with large inflammatory cells, Fundus: OD at 11 o'clock large subretinal granuloma in the periphery. Serum lysozyme was elevated (22.2 mg/l, normal range 10-17 mg/l), a syphilis stage II-III (TPHA 1:5000, VDRL neg.) and an IgG-antibody titre for Schistosoma mansoni of > 30 micrograms/ml was detected by enzyme immunoassay. In the faeces and urine no schistosoma eggs were found. Before the specific treatment for schistosomiasis could be initiated, the patient left the hospital because of reduced ocular pain due to the corticosteroids and fear of the side-effects of the treatment.DISCUSSION: In patients who present a subretinal granuloma and report a painful persistent diarrhoea, schistosomiasis, which is one of the most frequent tropical diseases should be considered, even if they have been living in central Europe for several years. Although the disease cannot become established due to the lack of specific hosts in this area, a curative treatment should be enforced in order to prevent late manifestations of chronic inflammatory organ manifestations.

KW - Adult

KW - Animals

KW - Antibodies, Helminth

KW - Diagnosis, Differential

KW - Eye Diseases

KW - Glaucoma, Open-Angle

KW - Granuloma

KW - Humans

KW - Immunoenzyme Techniques

KW - Immunoglobulin G

KW - Keratitis

KW - Male

KW - Retinal Diseases

KW - Retinal Vessels

KW - Schistosoma mansoni

KW - Schistosomiasis mansoni

KW - Uveitis

M3 - SCORING: Zeitschriftenaufsatz

C2 - 11699321

VL - 98

SP - 972

EP - 975

JO - OPHTHALMOLOGE

JF - OPHTHALMOLOGE

SN - 0941-293X

IS - 10

ER -