Current recommended treatment regimen of Brucellosis involves the use of

Current recommended treatment regimen of Brucellosis involves the use of two or more Deferoxamine mesylate including doxycycline, streptomycin, rifampin, gentamicin, or trimethoprim-sulfamethoxazole in combination to avoid relapses. In the present case report, initially the patient had received a combination of doxycycline and rifampicin as suggested in the literature. Additionally, intravenous ceftriaxone was also added to the regimen following PPV due to ongoing inflammation. Furthermore rifampicin was switched to trimethoprim-sulfamethoxazole because of side effects and she continued with a combination therapy of doxycycline and trimethoprim-sulfamethoxazole until 6th month of follow-up. The treatment duration was long because of severe inflammation due to initial mistreatment with immunosuppressive therapy elsewhere.

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Acknowledgment

Introduction
Atypical presentation of medulloepithelioma in the absence of definite mass lesion is a diagnostic challenge for ophthalmologists and radiologists. Herein, we report one such case of medulloepithelioma in a child with persistent hyperplastic primary vitreous (PHPV) and its rare late presentation as panophthalmitis and orbital cellulitis.

Case report

Discussion
Leukocoria, glaucoma, intra-ocular hemorrhage and retinal detachment in our case, all could be explained by PHPV in the absence of mass lesion, especially when retrolental membrane or stalk was visible. The presence of more than one unrelated pathology in the same eye is usually not expected unless there is evidence in favor of it or appearance of new features during follow-up which can be longer. Co-existence of PHPV and medulloepithelioma has been reported in 20% cases. Shields et al reported a similar case which clinically and radiologically appeared to be PHPV but there was no histopathological evidence of PHPV in enucleated specimen. Initial ‘Misdiagnosis’ and ‘delay in treatment’ are not uncommon with intra-ocular medulloepithelioma especially in the absence of classical features. Reports on intra-ocular medulloepithelioma presented as orbital cellulitis or panophthalmitis are sparse. Although lid swelling was mentioned in few scattered cases in the literature, no case was documented as orbital cellulitis. Broughton WL et al reported two cases presented as panophthalmitis and endophthalmitis, while Zhao HS et al reported one case as endophthalmitis. However, presentation of common pediatric intraocular tumor, i.e. retinoblastoma as aseptic inflammation is not uncommon and has been well documented. It has been hypothesized that the sterile inflammation is because of immune response to the necrotic material in the tumor. Beneficial role of systemic steroid is well established in such cases and one may repeat imaging after resolution of acute inflammation or can enucleate if there is no potential of vision in a disorganized globe.

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Introduction
Schwannoma, neurilemmoma, is a benign tumor that originates from the Schwann cells that form the neural sheath of the sensory nerves. Although schwannomas can arise from any nerve in the body, the most common areas include the nerves of head and neck, but not the ophthalmic ones. It is almost always benign in nature and while malignant forms have been documented in other areas of the body, primary schwannomas are very rarely reported in ophthalmology. We report here an extremely uncommon lid schwannoma and its successful long term management.

Case report
A 17-year-old Saudi male medically free presented to ophthalmology clinic complaining of a painless and slowly progressing lesion of the lateral angle of the left eye for nine years. The patient did not complain of any systemic disease and was not on any medications. On ocular examination, his visual acuity (V/A) was 20/20 OU. Slit lamp examination and fundoscopy of both eyes were within normal limits. The swelling was located at the lateral angle of the left eye and it was firm, non-tender, and mobile, with a smooth surface measuring 12×7mm, not adherent to underlying tissues or the skin. The mass did not affect the movement of the lid and did not cause ptosis. There was no neurological complaint associated with the lid lesion. The lesion was completely excised under local anesthesia through upper lid crease approach. The lesion was well-defined, capsulated, easily dissected and sent to histopathology lab in our hospital. Postoperatively, the patient was completely free of symptoms for two years with an excellent wound healing.