UNIVERSITY OPHTHALMOLOGY CONSULTANTS
 

CASE OF THE MONTH

CASE #19

 
DIAGNOSTIC WORKUP
 TEST   RESULT   REFERENCE RANGE   COMMENTS
CMV IgG Ab 0.04 <0.90 ISR Seronegative (no prior exposure)
CMV IgM Ab 0.29 <0.90 ISR Negative
Toxoplasma IgG Ab 1.66 <0.90 ISR Seropositive (indicates prior exposure)
Toxoplasma IgM Ab 0.25 <0.90 ISR Negative
Antinuclear antibodies Negative Negative Negative
Total complement CH100 49.0 48-153 U/ml Normal
Anti-DNA Ab Negative Negative Negative
Serum ACE 103.4 0.60-52.0 nmol/ml/min Elevated
Anticardiolipin IgG 7 0-14 Normal
Anticardiolipin IgM 13 0-9 Increased
C-ANCA <7 <7 Negative
P-ANCA <7 <7 Negative
ESR Performed twice: 15mm/h; 11mm/h Male: 0-15 mm/h
Female: 0-20 mm/h
Normal
Cryoglobulins Absent Absent Normal
C3 complement QN 0.703 g/L 0.86-1.84 g/L Decreased
Lyme Ab (ELISA) 0.28 <0.9 ISR Seronegative
C4 complement QN 0.196 0.20-0.59 g/L Low normal
Mg 1.15 0.66-1.10 mmol/L Elevated
WBC 10.5 4.0-10.5 k/uL Normal
Hb 129 135-170 g/L Decreased
Hct 39.7 39.8%-52.0% Decreased
Plt 141 140-450 k/uL Normal
Polys (polymorphonuclear leukocytes) 82 50%-75% Elevated
Lymphocytes 9 20%-40% Decreased
Atypical lymphocytes 3%   Elevated
Albumin 31 30-55 g/L Normal
Total protein 50 60-85 g/L Decreased
Glucose 6.22 3.89-6.38 mmol/L Normal
BUN 17.14 3.57-9.28 mmol/L Elevated
Creatinine 167.96 70.72-159.12 mmol/L Elevated
Sodium 138 136-145 mmol/L Normal
Potassium 3.9 3.5-5.0 mmol/L Normal
Chloride 107 96-106 mmol/L Elevated
Calcium 2.68 2.13-2.63 mmol/L Normal
Total bilirubin 10.26 3.42-20.52 micromol/L Normal
Alk Phos 58 30-136 U/L Normal
AST (SGOT) 15 7-58 U/L Normal
Inorganic Phosphorous 0.775 0.808-15.504 mmol/L Decreased
CO2 27 24-30 mmol/L Normal
Cyclosporin A (serum) 250, 258,250, 384 ng/ml    
Amylase 44 25-143 U/L Normal
Lipase 11 7-58 U/L Normal
Urinalysis Normal    
PTT 27 21.5-34.5 s Normal
PT 13.3 10.7-13.7 s Normal
INR 1.2    
Blood cultures Negative Negative Negative
Cholesterol 5.65 3.11-5.18 mmol/L Elevated
Triglycerides 7.67 0.113-2.15 mmol/L Elevated
HDL cholesterol 0.57 0.83-1.86 mmol/L Decreased
VLDL (calculated) 136 10-40 mg/dL Elevated
MRI/MRA of brain and thorax Questionable narrowed intracranial arteriole, otherwise normal    
Pelvic MRV Normal    
Lower extremity electromyogram Normal    
Echocardiogram Normal    
MUGA scan Normal    
Vitreous PCR for Toxoplasma gondii DNA Negative Negative Negative
Vitreous PCR for herpes simplex virus (HSV) DNA Negative Negative Negative
Vitreous PCR for herpes zoster virus DNA Negative Negative Negative

 

What was the clinical outcome?
       
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