Adult-onset Still’s disease (AOSD) is an inflammatory systemic disease of unknown aetiology, this may occur in any age in the adult and is associated with a diverse array of clinical symptoms. Typical symptoms of the disease are fever, arthralgias or arthritis, myalgias, the typical skin rash, sore throat, hepatosplenomegaly, lymphadenopathy and serositis. Characteristic laboratory abnormalities are elevated parameters of systemic inflammation, elevated liver enzymes, leukocytosis with predominant neutrophilia, anaemia and, in particular hyperferritinaemia. Typically the disease starts with systemic manifestations. The course of the disease can be self-limiting, intermittently active or chronic. If chronic, a destructive arthritis may often occur. Although the overall prognosis is favourable, severe and even life-threatening courses can develop. Because of the lack of a specific diagnostic test, the diagnosis of AOSD is based on clinical parameters after an exclusion of several differential diagnoses, in particular of infectious, malignant and autoimmune origin. In the acute disease non-steroidal anti-inflammatory drugs and systemically employed steroids are used for therapy. If they fail to induce sufficient control of disease activity, other drugs commonly used in the treatment of inflammatory diseases, such as DMARDs, in particular methotrexate, are used. In the past years, new therapeutic strategies for patients resistant to conventional therapy have successfully been employed with biologics, such as TNF-blockers and anakinra.
Background: Postoperative endophthalmitis can be subdivided into acute and chronic forms which are typically caused by different organisms. Enterococcus faecalis is an organism which normally causes an acute form of endophthalmitis. Patients and methods: We report on four cases of different forms of endophthalmitis following cataract extraction and intraocular lens (IOL) implantation who had been referred to our institution between 1998 and 2001. Enterococcus faecalis was the causative organism in all of them. Results: Two patients presented with an acute form and were immediately treated in our hospital after symptom onset utilizing pars plana vitrectomy with and without IOL explantation. The two other patients were initially treated with subconjunctival and/or systemic antibiotics and steroids over a period of about two months before referral to our hospital. After initial improvement the inflammation exacerbated in these two patients and vitrectomy with or without IOL and capsular bag explantation was performed. The explanted IOL and capsular bag of one patient were examined using scanning electron microscopy and it was shown that the enterococci were adherent to the IOL and the capsular bag. Conclusion: Enterococcus faecalis can be the causative organism both of an acute and of a recurrent form of postoperative endophthalmitis. The recurrent form may be caused by organisms which tend to adhere to the IOL and the capsular bag. This should be kept in mind when considering different treatment options.