Kyrieleis plaques in ocular toxocariasis: the first case reported Guardiola Fernández, Alicia Gómez molina, Celia Sánchez Martínez, Daniel Sellés Navarro, Inmaculada Servicio de Oftalmología, Hospital General Universitario Reina Sofía de Murcia, Departamento de Oftalmología, Optometría, Otorrinolaringología y Anatomía Patológica, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB) Virgen de la Arrixaca, Red Temática de Investigación en Ciencias de la Salud: RETICS: RD12/0034/0014.

Kyrieleis plaques in ocular toxocariasis: the first case reported INTRODUCTION Kyrieleis plaques were first described by Kyrieles in 1933 in a tuberculosis uveitis(1) Also known as segmental retinal periarteritis(2), are suspected to be an immune response to an infectious agent (3) Predominantly associated with toxoplasmosis, but also tuberculosis, syphilis, citomegalovirus, herpes simplex type 2 and herpes zoster virus and Ricketssia conori(4-9) The nature of the plaques is unknown No pathological study in the literature is available(4,5)

Kyrieleis plaques in ocular toxocariasis: the first case reported 64-years-old colombian immunocompetent woman with pain and blurry vision in the left eye Medical history: contact relative with active tuberculosis 10 years ago in Colombia Visual acuity was 0.4 on the left eye Anterior segment of the eye: Uveitis anterior with granulomatous keratic precipitates Posterior segment of the eye…

March 2014

March 2014

March 2014

Kyrieleis plaques in ocular toxocariasis: the first case reported Serology was negative for toxoplasmosis, family herpesviridae, HIV and syphilis Mantoux and Quantiferon tests were positive isoniazid + rifampicin + vitamin B6 for 6 months Treatment was established with systemic and topical corticosteroids, but despite it… clinical features got worse during first 3 months slow positive response and depending on the dose

Juny 2014

Juny 2014

Kyrieleis plaques in ocular toxocariasis: the first case reported Due to the clinical features (peripheral granuloma and vitreous band joining it to the papilla) we suspected ocular toxocariasis with Kyrieleis vasculitis Toxocara antibodies in serum were negative The absence of antibodies in serum doesn’t exclude the diagnosis(10) The treatment of ocular toxocariasis depends mainly on corticosteroids to reduce the inflammatory response(11) Anthelmintic therapy (benzimidazole derivative) is controversial because larval death increase the inflammatory reaction(12)

Kyrieleis plaques in ocular toxocariasis: the first case reported CONCLUSION Kyrieleis plaques have been described as an inflammatory response characterized by the deposition of inmune cells and inflamatory debris within o adjacent to the vessels walls that affects only arteries(3) We observe involvement of both arteries and veins with the characteristics that defines Kyrieleis vasculitis such as the intravascular dye filling and the absence of leakage in the fundus fluorescein angiography Kyrieleis plaques can persist or increased despite resolution of the infection and treatment with corticosteroids(9) In the literature, the association between ocular toxocariasis and Kyrieleis vasculitis has not been reported previously

Bibliography 1. Kyrieleis W. Uber atypische gerfaesstuberkulose der netzhaut. Arch Augenheilkd. 1933;107:182–190. 2. Griffin AO, Bodian M. Segmental retinal periarteritis; a report of three cases. Am J Ophthalmol. 1957;47:544–548 3. Orzalesi N, Ricciardi L. Segmental retinal periarteritis. Am J Ophthalmol. 1971;72:55–59. 4. Frances-Munoz E, Gallego-Pinazo R, Lopez-Lizcano R et al. Kyrieleis vasculitis in acute retinal necrosis. Clin Ophthalmol. 2010;4:837–838. 5. Patel A, Pomykala M, Mukkamala K et al. Kyrieles plaques in citomegalovirus retinitis. J Ophthal Inflamm Infect. 2011;1:189-191. 6. Empeslidis T, Konidaris V, Brent A et al. Kyrieles plaques in herpes zoster virus-associated acute retinal necrosis: a case report. Eye. 2013;27:1110- 1112. 7. Krishnamurthy R, Cunningham ET. Atypical presentation of syphilitic uveitis associated with Kyrieleis plaques. Br J Ophthalmol. 2008;92:1152– 1153. 8. Khairallah M, Ladjimi A, Chakroun M, et al. Posterior segment manifestations of Rickettsia conorii infection. Ophthalmol. 2004;111:529–534. 9. Schwartz PL. Segmental retinal periarteritis as a complication of toxoplasmosis. Ann Ophthalmol. 1977;9:157–162. 10. Singh A, Cunningham ET, Stewart J. Detection and treatment of ocular toxocariasis. Rev Ophthalmol. 2007; 14: 55-8 11. Macpherson CN. The epidemiology and public health importance of toxocariasis: a zoonosis of global importance. Int J Parasitol. 2013; 43: 999-1008. 12. Schneier AJ, Durand ML. Ocular toxocariasis: advances in diagnosis and treatment. Int Ophthalmol Clin. 2011; 51: 135-44.

Thank you

Kyrieleis plaques in ocular toxocariasis: the first case reported Guardiola Fernández, Alicia Gómez molina, Celia Sánchez Martínez, Daniel Sellés Navarro, Inmaculada Servicio de Oftalmología, Hospital General Universitario Reina Sofía de Murcia, Departamento de Oftalmología, Optometría, Otorrinolaringología y Anatomía Patológica, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB) Virgen de la Arrixaca, Red Temática de Investigación en Ciencias de la Salud: RETICS: RD12/0034/0014.