Faculty Bibliography

IgG deficiency can predispose to recurrent pyogenic infections. The association of IgG deficiency with Clostridium difficile infection has been infrequently reported in the literature. We present a case of a middle-age woman with multiple hospitalizations for recurrent C. difficile in a short span of time which prompted consideration of a possible fecal transplant. On evaluation, she was found to have low total IgG, with subclass analysis revealing low IgG1 and IgG3. She was started on monthly infusions of immunoglobulins and one year after her last episode of C. difficile she has not had any recurrence. The role of immunoglobulin infusion in the treatment of recurrent C. difficile is controversial, with some studies revealing no clear evidence of benefit. Our case report suggests that the patients who have underlying IgG deficiency may benefit from immunoglobulin, as this can significantly reduce the incidence of recurrent infections and hence save the healthcare costs.

PURPOSE: To describe the clinical features and histopathology of epibulbar osseous choristoma in a series of patients. METHODS: Noncomparative case series with chart review of 8 patients. RESULTS: At presentation, the mean age of the patients was 19 years (median, 19 years; range, 0.8-38 years), with 6 women and 2 men (6 Caucasian, 1 Hispanic, and 1 African American). There were no related systemic syndromes, and visual acuity was unaffected in all cases. The choristoma was superotemporal (n = 8, 100%), with epicenter located in the fornix (n = 8, 100%), deep to Tenon fascia (n = 8, 100%), and of yellow (n = 2, 25%), white (n = 2, 25%), or pink (n = 4, 50%) color. The mean basal dimension was 9 mm (median, 10 mm; range, 3.5-14 mm), and mean thickness was 4 mm (median, 4 mm; range, 2-5 mm). Four cases were managed with observation and 4 with surgical excision, revealing tumor base adherent to the episclera (n = 2, 50%) or loose within Tenon fascia (n = 2, 50%). There were no cases to demonstrate intrascleral involvement, growth, or recurrence. CONCLUSIONS: Epibulbar osseous choristoma is a congenital lesion of mature bone located superotemporally in the fornix at the level of Tenon fascia or episclera in young patients.

PURPOSE: To describe sector (partial) involvement of the uvea with melanocytosis. DESIGN: Noninterventional, retrospective case series. PARTICIPANTS: A total of 89 eyes of 86 patients. METHODS: Review of medical records, color photographs, and ultrasound images. MAIN OUTCOME MEASURES: Clinical features and relationship with uveal melanoma. RESULTS: Approximately all patients were Caucasian (n = 83, 97%), and sector melanocytosis involved the right (n = 41, 46%) or left (n = 48, 54%) eye. The involved tissue included iris (n = 58, 65%), choroid (n = 48, 54%), and both iris and choroid (n = 17, 19%). The melanocytosis affected a mean of 6 clock hours of iris and 5 clock hours of choroid. Related melanocytosis involved the sclera (n = 39, 44%), eyelid (n = 4, 4%), temple (n = 4, 4%), scalp (n = 1, 1%), and palate (n = 1, 1%). Uveal melanoma was found at presentation in 7 patients (8%) and was multifocal in 2 of these patients. A comparison of eyes with versus without melanoma revealed clinically significant factors (odds ratio [OR] > 2) of male gender (71% vs. 43% [OR 3.36]); cutaneous/palate melanocytosis (14% vs. 7% [OR 2.11]); scleral melanocytosis heaviest in superior, temporal, or nasal quadrants (57% vs. 29% [OR 2.41, confidence interval, 2.24-3.92]); and any degree of choroidal melanocytosis (86% vs. 70% [OR 2.63]), particularly diffuse choroidal melanocytosis (29% vs. 16% [OR 3.85]). None of these factors reached statistical significance in this small cohort. Over a mean follow-up of 6 years, there was no metastatic event. CONCLUSIONS: Ocular melanocytosis can be sectoral (partial), affecting only a mean of 5 to 6 clock hours of the uvea and can manifest melanoma within the melanocytosis region. There were no specific features of melanocytosis statistically related to the presence of melanoma. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.