Subretinal granuloma, retinal vasculitis and keratouveitis in schistosomiasis
A. A. Bialasiewicz, A. Hassenstein, U. Schaudig
Introduction: 200 million people in africa and asia suffer of schistosomiasis. Epibulbar and extraocular granulomas were described, but intraocular manifestations are rare.
Patient und follow-up: We present a 32 y old patient from Gambia, who suffered of schistosomiasis (which was diagnosed by a skin tes) and did not treat the disease because of side effects and who lived since 3 years in Germany. On admission he complained of abdominal pain and spasm, fever and deterioration of visual acuity L>R. On admission his visual acuity was OD 0.75sph 0.8, OS sc 1.0, IOD OD 31, OS 18mmHg. Biomicroscopy: R>L fatty retrocorneal precipitates, especially in the lower circumference (ARLT), cells and Tyndall ++, vitreous with inflammatory cells, Fundus: OD at 11oclock big subretinal granuloma in the periphery. Lysozyme i.S. was elevated (22.2mg/l (ref. 10-17)) and Syphilis at stage II-III (TPHA 1:5000 and negative VDRL) and a IgG-antibody titer of schistosoma mansoni by enzymimmunoassay was detected. In feces and urine no schistosoma was found. The antiluetic treatment was continued; the specific schistosomiasis treatment was again refused because of the side effects known by the patient.
Discussion: Intraocular manifestations in schistosomiasis such as iridocyclitis, retinal granulomas, occlusive retinal vasculitis, retinitis, choriocapillaritis and optic neuritis are described. Intraocular granulomas in the infectionmodell in New Zealand White Rabbits can be caused as a single immunreaction without any active parasite. In our case describe above we assume a similar immune reaction because of the long standing history without any complications as a fulminant eosinophile endophthalmitis caused by an active parasite.
University Eye Hospital Hamburg, Eppendorf, Martinistr. 52, D- 20251 Hamburg, Germany