Dendritic Lesions Research Articles

Top Ten Lymphoproliferative Lesions Not to Miss When Evaluating Oral Ulcer Biopsies.

Oral ulcers represent afull thickness lossof the mucosal epithelium leading to exposure of the submucosal connective tissue. These are common and usually self-limited lesions, although they may sometimes result from neoplasms, most commonly squamous cell carcinoma. Lymphoproliferative disorders may be difficult to diagnose in apthous ulcers since they mimic reactive inflammation. This review presents ten rare oral lymphoid proliferations which should not be missed when assessing oral ulcer biopsies. The ten lesions include several with diagnostic cells which look similar to the histiocytes of a reactive inflammatory ulcer, including Rosai-Dorfman disease, reticulohistiocytoma, Langerhans cell histiocytosis, and traumatic ulcerative granuloma. Other lesions, such as EBV-positive mucocutaneous ulcer, extranodal marginal zone lymphoma of mucosal-associated lymphoid tissue, and plasmablastic lymphoma have lymphoid and/or plasma cell differentiation that mimic the reactive lymphocytes and plasma cells foundin reactive ulcers. Two dendritic cell lesions, follicular dendritic cell sarcoma and blastic plasmacytoid dendritic cell neoplasm, both have distinct phenotypes which are required to make an accurate diagnosis. Each of these lesions are diagnosed by evaluating their histology, along with their phenotypic profile, which is sometimes enhanced by pertinent molecular findings.

Bilateral Herpes Simplex Keratoconjungtivitis: A Case Report

Introduction: Herpes Simplex Virus (HSV) is one of the DNA viruses known to infect the human eye. Herpes simplex keratitis is, in general, a unilateral disease. Simultaneous bilateral involvement is a rare occurrence that has been observed in patients with compromised immune systems. Purpose: To report a case of bilateral herpes simplex keratoconjunctivitis Case Report: A 22-year-old man arrives with the primary complaint of redness in both eyes in the last four days. The patient complained of blurred vision, tearing, and foreign body sensations. Ophthalmology examination of both eyes revealed visual acuity of 1.0 in the right eye and 0.8 in the left eye, a dendritic lesion, and a decrease in corneal sensation. Patient was diagnosed with bilateral keratoconjunctivitis HSV and was treated with acyclovir ointment, levofloxacin eye drops, acyclovir 400 mg five times a day, and vitamin C 500 mg. Discussion: Bilateral herpes simplex keratitis can occur in both immunocompromised and immunocompetent individuals. Recurrence of HSV infectious keratitis is common. Factors such as emotional stress, fever, postoperative tear dysfunction, ultraviolet (UV-A) radiation exposure, and ocular (accidental or surgical) trauma have also been related to the reactivation of the herpes simplex virus. History, physical, and laboratory examinations support the patient?s diagnosis in order to get the appropriate treatment. Conclusion: Simultaneously occurring bilateral herpetic keratitis has a high proportion of complications, either because of the greater virulence of the virus or because of altered host susceptibility. Therefore, prompt administration of medication upon diagnosis is essential to reduce the severity and frequency of viral attacks and delay the progression of corneal damage.

Plasmacytoid Dendritic Cell Dermatosis Associated to Myeloproliferative/Myelodysplastic Neoplasms.

Cutaneous lesions in the setting of myeloproliferative neoplasms and myelodysplastic syndromes are poorly understood. We report 6 patients with pruritic papular eruptions composed of mature T-lymphocytes with large clusters of CD123-positive cells. Double immunohistochemical studies demonstrated a lack of myeloid cell nuclear differentiation antigen in the CD123-positive cells, which expressed SPIB, confirming that they were mature plasmacytoid dendritic cells. Four patients were diagnosed with chronic myelomonocytic leukemia and 2 with myelodysplastic syndromes (AREB-I and myelodysplastic syndromes with 5q deletion, respectively). All patients had a long history of hematological alterations, mainly thrombocytopenia, preceding the cutaneous disorder. Nevertheless, the skin lesions developed in all cases coincidentally with either progression or full-establishment of their hematological disease. Most cutaneous lesions disappeared spontaneously or after corticosteroid treatment. Molecular studies performed in both bone marrow and cutaneous lesions in 2 patients demonstrated the same mutational profile, confirming the specific, neoplastic nature of these mature plasmacytoid dendritic cells-composed cutaneous lesions.

Assessment of corneal endothelial cell morphology and anterior segment parameters in COVID-19.

Background:The ocular manifestations of the 2019 novel coronavirus disease (COVID-19) vary from acute follicular, pseudomembranous, and hemorrhagic conjunctivitis to keratoconjunctivitis with subepithelial infiltrates and dendritic lesions. Similar to other respiratory viruses, such as adenoviruses, it is thought that COVID-19 may impact the cornea. However, its impact on the cornea and anterior segment parameters are currently poorly understood.Objective:This study aims to assess the corneal endothelial cell morphology and anterior segment parameters in patients who have recovered from COVID-19.Methods:In this cross-sectional study, the COVID-19 group comprised 34 patients who had been diagnosed with and recovered from COVID-19, while the control group comprised age- and sex-matched individuals without any systemic or ocular diseases. The endothelial cell density (ECD), coefficient of variation (CV) of cell area, hexagonal cell percentage (HEX), anterior chamber depth (ACD), central corneal thickness (CCT), horizontal anterior chamber diameter (HACD), iridocorneal angle (ICA), horizontal visible iris diameter (HVID), pupillary diameter (PD), and keratometry values (K1 and K2) were analyzed for each participant. The differences in each of these between the groups were analyzed using either an independent samples t test or a Mann–Whitney U test based on the normality of the data.Results:Regarding corneal endothelial cell morphology, the ECDs for the COVID-19 and control groups were 2278.50 ± 186.78 cells/mm2 and 2420.15 ± 222.25 cells/mm2, respectively (p = 0.002). A significant increase was noted in CV values in the COVID-19 group compared with the control group (p < 0.001). The HEX values for the COVID-19 and control groups were 56.26 ± 5.75 and 61.50 ± 3.63, respectively (p < 0.001). Regarding the anterior segment parameters, no significant differences were observed between the groups (p > 0.05).Conclusions:It was hypothesized that individuals who had recovered from COVID-19 would demonstrate a reduction in their endothelial functional preserves. A decrease in ECD and HEX and an increase in CV were observed in the individuals during their early post-recovery period from COVID-19.

Histiocytic and dendritic cell neoplasms of the mediastinum.

In this review, we discuss a logical approach to diagnosis of histiocytic and dendritic cell lesions of the mediastinum. We break down the differential diagnosis between true neoplasms of histiocytic and dendritic cells [Rosai-Dorfman disease (RDD), Langerhans cell histiocytosis (LCH), and follicular dendritic cell sarcoma (FDCS)] versus selected neoplasms of other lineages which frequently attract non-neoplastic histiocytes or resemble them morphologically (carcinoma, melanoma, sarcoma, germinoma, mesothelioma, and lymphoma). As neoplasms in the latter category are more common, they should be stringently excluded before diagnosing a lesion in the first group, particularly given enormous differences in clinical management. We also consider histiocytic sarcoma (HS), an extremely rare lesion which, in some cases is likely of intrinsic histiocytic differentiation, whereas in others represents clonal evolution from an underlying non-histiocytic neoplasm.

Hemorrhagic hypopyon as presenting feature of intravascular lymphoma, a case report

BackgroundHerpes uveitis has been previously reported to present with hyphema, but hemorrhagic hypopyon is rarely reported as a herpetic uveitis manifestation. We report a case of herpes simplex virus (HSV) presenting with hemorrhagic hypopyon, and speculate on the underlying pathophysiology with relation to an intravascular lymphoma which was subsequently diagnosed as a result.Case presentationWe present a case wherein a 62-year-old Japanese rheumatoid arthritis woman, with HSV uveitis, presented with hemorrhagic hypopyon in the anterior chamber and a fever with photophobia. Patient was treated with antiviral drugs which improved the hyphema and corneal lesions, but lesions recurred 3 months later. This rare presentation of HSV induced uveitis, and its subsequent recurrence, aroused suspicion of an additional hypopyon-inducing pathology. On account of previous history of lung opacities and elevated LDH, intravascular lymphoma was eventually diagnosed via lung biopsy. She was treated for the lymphoma which also completely resolved all ocular symptoms without any recurrence as of 1.5 years later.ConclusionThe exceedingly rare presentation of hemorrhagic hypopyon may have been enabled by an interaction of the HSV with the intravascular lymphoma. HSV involvement was indicated by the dendritic lesions, IgG assay, and response to anti-viral drugs. The ocular involvement of the intravascular lymphoma seems to be indicated by virtue of the anti-tumor drugs completely resolving all ocular symptoms.

Self-Retained Amniotic Membrane Combined With Antiviral Therapy for Herpetic Epithelial Keratitis.

To evaluate the therapeutic benefit of self-retained cryopreserved amniotic membrane in conjunction with oral antiviral therapy in herpetic epithelial keratitis. Retrospective review of 4 patients with primary (1 eye) and recurrent (3 eyes) unilateral herpetic epithelial keratitis treated with cryopreserved amniotic membrane through the placement of the PROKERA Slim (PKS) (Bio-Tissue, Inc) in conjunction with oral acyclovir. Their symptoms, conjunctival inflammation, corneal staining, and visual acuity were compared before and after treatment. Herpetic epithelial keratitis presented as dendritic (3 eyes) and geographic (1 eye) epithelial lesions. After epithelial debridement and placement of the PKS for 5 ± 3.7 days, all patients reported significant relief of symptoms, rapid corneal epithelialization, and reduction of ocular surface inflammation. The visual acuity was also improved in all eyes from 0.7 ± 0.7 to 0.4 ± 0.7 logarithm of the minimum angle of resolution (P = 0.2). They remained symptom-free during a follow-up period of 2.7 to 50.8 (20.3 ± 21.7) months. The PKS in conjunction with oral acyclovir facilitates the ease of early intervention to accelerate restoration of a normal corneal epithelium in herpetic epithelial keratitis.

PEDF plus DHA modulate inflammation and stimulate nerve regeneration after HSV-1 infection

Herpes simplex virus type-1 (HSV-1) infection leads to impaired corneal sensation and, in severe cases, to corneal ulceration, melting and perforation. Here, we explore the potential therapeutic action of pigment epithelial-derived factor (PEDF) plus docosahexaenoic acid (DHA) on corneal inflammation and nerve regeneration following HSV-1 infection. Rabbits inoculated with 100,000 PFU/eye of HSV-1 strain 17Syn+ were treated with PEDF + DHA or vehicle. PEDF + DHA treatment resulted in a biphasic immune response with stronger infiltration of CD4+T cells, neutrophils and macrophages at 7-days post-treatment (p.t.) that was significantly decreased by 14 days, compared to the vehicle-treated group. Screening of 14 immune-related genes by q-PCR showed that treatment induced higher expression of IFN-γ and CCL20 and inhibition of IL-18 by 7 days in the cornea. PEDF + DHA-treated animals developed less dendritic corneal lesions, opacity and neovascularization. Corneal nerve density increased at 12-weeks p.t. with functional recovery of corneal sensation. Treatment with PEDF + DHA that was postponed by 3 weeks also showed increased nerve density when compared to vehicle. Our data demonstrate that PEDF + DHA promotes resolution of the inflammatory response to the virus and, most importantly, induces regeneration of damaged corneal nerves vital for maintaining ocular surface homeostasis.

Mapping of dendritic lesions in patients with herpes simplex keratitis using in vivo confocal microscopy.

PurposeTo produce a two-dimensional reconstruction map of dendritic lesions in patients with herpes simplex keratitis (HSK) using in vivo confocal microscopy.MethodsFour eyes of four patients (mean 65.8 years) with HSK presenting with a dendritic lesion were enrolled. Slit-lamp biomicroscopy and in vivo laser confocal microscopy were performed. Acquired confocal images at the level of the epithelium were arranged and mapped into subconfluent montages. Changes in the shape and degree of light reflection of abnormal cells and deposits around dendritic lesions as well as other corneal layers were qualitatively evaluated.ResultsMapping of dendritic lesion was successful in all cases, and the subconfluent montages clearly showed the larger image of dendritic lesion. In all cases, the dendritic lesion consisted of hyperreflective irregular epithelial cells, and was surrounded by distorted and elongated epithelial cells. In three cases, hyperreflective deposits were noted at the midline of the lesion. The corneal stroma showed a hyperreflective honeycomb pattern. In two cases, inflammatory cells were observed at the level of endothelial cell layer.ConclusionMapping of dendritic lesions in patients with HSK was successful in all patients using in vivo confocal microscopy. Cellular level observation of dendritic lesion at a relatively larger magnification may help understand the in vivo morphological change of HSK. Further study in more patients with HSK and nonherpetic dendritic lesion is needed to utilize confocal microscopy images in differential diagnosis and follow-up of the epithelial lesions with dendrite.

Coinfection with Herpes Zoster Ophthalmicus and Oriental Eye Worm in a Rural Woman: The First Report of an Unusual Case

Dear Editor: A 70-year-old Korean rural woman presented with a 7-day history of painful facial cutaneous lesions and severe ocular pain. Her general condition was good except for hypertension. Upon examination, there was erythema, vesiculobullous lesions and crusted erosions on the right side of the forehead and cheek. Also, there was right-sided periorbital edema confined to the cutaneous surface innervated by the ophthalmic division of the fifth cranial nerve (Fig. 1A). Because the Hutchinson's sign, ocular erythema, and foreign body sensation were present, she was referred to an ophthalmologist. Ophthalmologic examination showed perilimbal and conjunctival injection. No dendritic and inflammatory lesions were observed in the anterior chamber. Therefore, the diagnosis of herpes zoster ophthalmicus (HZO) was made. After admission, intravenous acyclovir (10 mg/kg) and analgesics were administered. However, despite the improvement in her cutaneous lesions and pain, the ocular pain and foreign body sensation persisted. At the second ophthalmologic examination, a chalky-white, 12.4×0.44 mm in size, thread-like worm was found in the right bulbar conjunctiva at the 8 o'clock position (Fig. 2) and it was removed. A parasitologist confirmed that the worm was an oriental eye worm. After 7 days, the initial signs and symptoms subsided. Only scattered crusted scars were observed (Fig. 1B). Fig. 1 (A) Erythema, edema, vesiculobullous eruptions, crusted erosions were present on the right side of the forehead, and yellowish lacrimation was noted from the right orbital area in the initial state and (B) after 7 days of treatment. Note the vesicles ... Fig. 2 A white, slender, thread-like worm (Thelazia callipaeda, 12.4×0.44 mm in size) was removed from the right bulbar conjunctiva of the patient. HZO is defined as herpes zoster involvement of the ophthalmic division of the fifth cranial nerve. Hutchinson's sign is defined as skin lesions at the tip, side, or root of the nose, and it is a strong predictor of ocular inflammation and corneal denervation in HZO1. When the ophthalmic division is affected and Hutchinson's sign is present, unexplained painful ocular injection or visual problems can be observed. And serious visual impairment could also occur2. Nematodes belonging to the genus Thelazia, commonly known as eye worms, infect orbital cavities and associated tissues of several mammals. The two species known to cause human thelaziasis are Thelazia callipaeda and Thelazia californiensis. Thelazia callipaeda is known as the 'oriental eye worm' because of its distribution in countries in the Far East, while Thelazia californiensis is found in the United States3,4. The final hosts of these nematodes include dogs and cats, but occasionally rabbits, monkeys, raccoons, foxes, and humans can also serve as the final host. When a fly licks the tear in the eye of a final host, the larvae enter the conjunctival sac, and become adults in 1 month after 2 molts5. The common symptoms of infestation are itching, tearing, foreign body sensation, and photophobia. Therefore, it is important to include human thelaziasis in the differential diagnosis of bacterial or allergic conjunctivitis. The optimal treatment is removal of the worm by using forceps3,4. In this case, the cutaneous and ocular symptoms in the patient were not only due to HZO but also due to parasitic infestation. Because the Hutchinson's sign was present, we initially thought that her ocular pain was an inevitable symptom of HZO. However, these symptoms completely disappeared only after the removal of the eye worm. In conclusion, we presented an unusual case of coinfection with HZO and oriental eye worm in a rural Korean woman. Human thelaziasis could cause ocular problems similar to HZO, too. Therefore, in cases of refractory HZO, a careful ophthalmologic examination should be considered to exclude other conditions including human thelaziasis, especially in patients living in a rural area or raising domestic animals.

Intrinsic Up-Regulation of 2-AG Favors an Area Specific Neuronal Survival in Different In Vitro Models of Neuronal Damage

BackgroundThe endocannabinoid 2-arachidonoyl glycerol (2-AG) acts as a retrograde messenger and modulates synaptic signaling e. g. in the hippocampus. 2-AG also exerts neuroprotective effects under pathological situations. To better understand the mechanism beyond physiological signaling we used Organotypic Entorhino-Hippocampal Slice Cultures (OHSC) and investigated the temporal regulation of 2-AG in different cell subsets during excitotoxic lesion and dendritic lesion of long range projections in the enthorhinal cortex (EC), dentate gyrus (DG) and the cornu ammonis region 1 (CA1).Results2-AG levels were elevated 24 h after excitotoxic lesion in CA1 and DG (but not EC) and 24 h after perforant pathway transection (PPT) in the DG only. After PPT diacylglycerol lipase alpha (DAGL) protein, the synthesizing enzyme of 2-AG was decreased when Dagl mRNA expression and 2-AG levels were enhanced. In contrast to DAGL, the 2-AG hydrolyzing enzyme monoacylglycerol lipase (MAGL) showed no alterations in total protein and mRNA expression after PPT in OHSC. MAGL immunoreaction underwent a redistribution after PPT and excitotoxic lesion since MAGL IR disappeared in astrocytes of lesioned OHSC. DAGL and MAGL immunoreactions were not detectable in microglia at all investigated time points. Thus, induction of the neuroprotective endocannabinoid 2-AG might be generally accomplished by down-regulation of MAGL in astrocytes after neuronal lesions.ConclusionIncrease in 2-AG levels during secondary neuronal damage reflects a general neuroprotective mechanism since it occurred independently in both different lesion models. This intrinsic up-regulation of 2-AG is synergistically controlled by DAGL and MAGL in neurons and astrocytes and thus represents a protective system for neurons that is involved in dendritic reorganisation.

Ganciclovir Ophthalmic Gel in the Treatment of Herpes Simplex Keratitis

Herpes simplex keratitis (HSK) is the most common form of viral keratitis and is a common cause of ocular morbidity and blindness. HSK is caused by the herpes simplex virus (HSV) and occurs in patients with no previous exposure to HSV typically occurring during childhood, or in patients with latent disease bearing dormant virus in the nerve ganglia or the cornea. HSK initially presents as a cluster of small, clear vesicles in the epithelium that accumulates to form dendritic lesions which can progress to geographic ulcers, whilst further progression of infection deeper into the cornea affects the stroma. Ganciclovir (GCV) was developed for the treatment of acute superficial herpetic keratitis as a replacement for earlier, less effective, or less tolerated antiviral therapy. Studies have found topical GCV gel treatment to be safe and well tolerated with more favorable pharmacokinetics than acyclovir. The recent approval by the US Food and Drug Administration (FDA) for the clinical use of 0.15% GCV gel for treatment of HSK will provide patients and physicians with a more tolerable, convenient, and effective treatment.

The Utility of PU.1 as an Immunohistochemical Marker for Histiocytic and Dendritic Lesions of the Skin

PU.1 is a transcription factor restricted to the hematopoietic system. It is expressed in myeloid lineage and B lymphocytes but is absent in mature T cells and nonhematopoietic cells. Among myeloid lineage-derived cells, PU.1 is overexpressed in monocytes, histiocytes, and dendritic cells. We evaluated PU.1 expression in 78 cases of primary skin neoplasms, including 9 reticulohistiocytomas, 9 Langerhans cell histiocytoses, 7 juvenile xanthogranulomas, 9 fibrous papules, 8 dermatofibromas, 12 dermatofibrosarcoma protuberans, 9 Spitz nevi, and 15 malignant melanomas. Strong nuclear staining for PU.1 was seen in all cases of histiocyte and dendritic cell origin, including 9/9 reticulohistiocytomas, 9/9 Langerhans cell histiocytoses, and 7/7 juvenile xanthogranulomas. No staining for PU.1 was seen in any studied cases of fibrous papules, dermatofibrosarcoma protuberans, dermatofibromas, Spitz nevi, or malignant melanomas. This study indicates that PU.1 is a valuable immunohistochemical marker for identifying cutaneous histiocyte- and dendritic cell-derived lesions. PU.1 staining is easily interpreted due to the sharp nuclear staining as compared with the irregular and often variable cytoplasmic staining seen with CD68.

Herpetic Epithelial Keratitis After Intravitreal Injection of Bevacizumab (Avastin)

To report a case of herpetic epithelial keratitis that developed after intravitreal bevacizumab (Avastin) injection. A 63-year-old man with diabetes with proliferative diabetic retinopathy and macular edema received intravitreal injection of bevacizumab (Avastin) in his right eye. Three days after the injection, the patient presented with foreign body sensation, redness, tearing, photophobia, and decreased visual acuity in the right eye. The cornea showed an arborizing dendritic epithelial lesion with terminal bulb typical of herpes simplex virus (HSV) epithelial keratitis. HSV-DNA was detected in corneal scrapings using polymerase chain reaction. A diagnosis for herpes simplex epithelial keratitis was made. Topical acyclovir ointment therapy was initiated with good resolution of HSV signs and symptoms. Herpes simplex epithelial keratitis can be a possible complication of intravitreal bevacizumab (Avastin) injection. To our knowledge, this case is the first report of herpetic epithelial keratitis after intravitreal bevacizumab (Avastin) injection.

Malignant blue nevus with lymph node metastases

Malignant blue nevi arise within cellular blue nevi and contain atypical mitoses, necrosis, nuclear pleomorphism and prominent nucleoli. Malignant blue nevus has been described as a distinct identity, a rare form of malignant melanoma, and a misdiagnosed melanoma. We present a patient with metastatic malignant blue nevus and studies on the histopathologic, immunohistochemical, and molecular features of the neoplasm. Histology showed a malignant blue nevus arising in a combined intradermal and cellular blue nevus. CD117 (c-kit) staining showed diffuse cytoplasmic expression within the cellular blue nevus, decreased staining in the malignant component, and variable positivity within the lymph node metastases. Molecular loss of heterozygosity analysis showed different allelic patterns at the hOGG-1 locus between the melanoma and control skin specimens with a varying heterozygous allelic pattern in both the benign and malignant blue nevus. Our case of malignant blue nevus with lymph node metastasis involved mutation of the hOGG-1 DNA repair gene. CD117 showed decreased staining of the primary malignant blue nevus with marked upregulation in the metastatic lesion, unlike most metastatic melanomas. Further study is needed to determine if hOGG-1 mutation or c-kit upregulation play a role in the pathogenesis of dendritic melanocytic lesions (either benign or malignant).

Evidence of altered calmodulin immunoreactivity in areas 9 and 32 of schizophrenic prefrontal cortex

Schizophrenia is a severe neuropsychiatric disorder. Previous studies have implicated the prefrontal cortex (PFC) [Harrison PJ. The neuropathology of schizophrenia a critical review of the data and their interpretation. Brain 1999;122:593–624; Jones LB. Recent cytoarchitectonic changes in the prefrontal cortex of schizophrenics. Frontiers of Bioscience 2001;6:E148–53]. Recent immunocytochemical studies have shown a dramatic decrease in MAP2 and neurogranin [Jones L, Johnson N, Byne W. Alterations in MAP2 staining in area 9 and 32 of schizophrenic prefrontal cortex. Psychiatry Research 2002;114:137–48; Broadbelt K, Pamprasaud A, Jones LB. Evidence of altered neurogranin immunoreactivity in areas 9 and 32 of schizophrenic prefrontal cortex. Schizophrenia Research 2006;87:6–14] a loss of either is suggestive of dendritic lesions [Li GL, Farooque M, Lewen A., Lennmyr F, Holtz A., Olsson Y. MAP2 and neurogranin as markers for dendritic lesions in cns injury an immunohistochemical study in the rat. APMIS 2002;108:98–106.]. Neurogranin is an upstream regulator of calcium and calmodulin [Prichard L, Deloulmes JC, Storm DR. Interactions between Neurogranin and Calmodulin in vivo. Journal of Biological Chemistry 1999;274:7689–94]. A direct action of this pathway is the phosphorylation of MAP2, which is required for microtubule stabilization. Because of the above findings as well as moropholigical alterations [Broadbelt K, Byne W, Jones LB. Evidence for a decrease in primary and secondary basilar dendrites on pyramidal cells in area 32 of schizophrenic prefrontal cortex. Schizophrenia Research 2002;58:75–81] we examined the expression of the active form of calmodulin in layers III and V of areas 9 and 32 in six controls and six schizophrenics matched for age, sex, and postmortem interval. Using area fraction analysis we quantified immunostaining and counted the number of immunopositive pyramidal cells and interneurons as well as immunonegative pyramidal cells. Area fraction analysis showed a significant decrease in immunostaining in area nine layers III (58%) and V (44%), area 32 layers III (51%) and V (32%). We found a significant reduction in the density of immunopositive pyramidal cells in area 9 (11%) layer III, (20%) layer V, area 32 (16%) layer III and (17%) layer V with no difference in immunopositive interneurons. These data suggest a loss of the active form of calmodulin with pyramidal cells being preferentially affected suggesting that the calcium calmodulin dependent pathway may be altered in the pyramidal cells in the PFC.

Ocular Involvement Associated With an Epidemic Outbreak of Chikungunya Virus Infection

To study the range of ocular symptoms in a cohort of patients with chikungunya infection. Retrospective, observational case series. Patients attending a tertiary eye care hospital in South India were included in the study. We included adult patients with serologically confirmed chikungunya virus infection who received clinical care at the Aravind Eye Hospital, Madurai, South India. They were assessed for demographic characteristics, ocular symptoms, laboratory parameters, and chikungunya virus infection severity. Patients underwent a complete ophthalmologic examination that included visual acuity, slit-lamp examination, and indirect funduscopic examination. Visual outcome at the end of three months was the main outcome measure. The charts of 37 patients were analyzed based on the clinical picture and the serologic results. Forty patients were included as controls and tested negative. There were 21 males and 16 females with a mean age of 44.17 years. The main ocular symptoms included granulomatous and nongranulomatous anterior uveitis, optic neuritis retrobulbar neuritis, and dendritic lesions. Of the 26 patients who were followed up for three months, the visual acuity improved in 11 patients (42.3%), remained the same in 12 patients (46.15%), and worsened in three patients (11.5%). The main ocular manifestation associated with the recent epidemic outbreak of chikungunya virus infection in South India included granulomatous and nongranulomatous anterior uveitis, optic neuritis, retrobulbar neuritis, and dendritic lesions. The visual prognosis generally was good, with most patients recovering good vision. Further studies are needed to understand the pathogenesis of this disease.

Herpetic Optic Neuritis Associated with Herpetic Keratitis

To report a case of herpetic optic neuritis associated with herpetic keratitis. A 65 year old woman presented with oedema in the nasal sector of his right papilla. Blood biochemistry, a haemogram, erythrocyte sedimentation rate and C-reactive protein were all normal. The patient was diagnosed as having a non-arteritic anterior ischaemic optic neuropathy. One week later slit lamp examination showed diffuse stromal corneal oedema and a dendritic lesion in the nasal zone of the corneal epithelium. Serology for varicela-zoster virus was positive. Treatment was started with valacyclovir given orally and topical acyclovir ointment. A week later, the optic disc swelling and corneal lesions had resolved. The precise mechanism through which the papilla and cornea were successively affected in our patient is unclear but the sensitive innervation of both these structures is provided by the nasal branch of the nasociliary nerve and the spread of herpes via this nerve could affect both sites.

Herpes Simplex Keratitis After Cataract Surgery

Herpetic keratitis is a rare complication of cataract surgery. We describe 3 cases of herpes simplex keratitis after cataract surgery in eyes with no clinical history of this disease. Three patients underwent uneventful phacoemulsification of cataract with intraocular lens implantation. All were treated postoperatively with topical steroids. On subsequent development of corneal dendritic epithelial lesions in the operated eyes, the corticosteroids were replaced by treatment with topical acyclovir. The first postoperative day was uneventful. Corneal dendritic epithelial lesions were observed 1-5 weeks postoperatively and healed without sequelae after topical acyclovir treatment. In view of the surgical trauma along with the topical corticosteroid treatment commonly prescribed after cataract surgery, physicians should be aware of the possible development of herpetic epithelial keratitis even in patients with no clinical history of this disease.

Herpes Simplex Keratitis After Intravitreal Triamcinolone Acetonide

To report a case of recurrent herpes simplex virus (HSV) epithelial keratitis after intravitreal triamcinolone acetonide injection for the treatment of diabetic macular edema. Case report. We describe a case of a 59-year-old woman with a history of ocular HSV disease and severe proliferative diabetic retinopathy. She received an intravitreal injection of triamcinolone acetonide for macular edema in the right eye. One week later, she developed foreign body sensation, redness, and photophobia in the same eye. Slit-lamp examination revealed a corneal epithelial dendritic lesion. She was diagnosed with a recurrence of HSV epithelial keratitis and was treated with oral acyclovir 400 mg, 5 times a day, with good resolution of HSV signs and symptoms. Intravitreal triamcinolone acetonide injection may result in reactivation of HSV keratitis.