Retinoschisis is a common complication in patients with PP. It is typically bilateral, and may develop or progress, despite control of uveitis.

While our sample was small, these findings suggest racial and gender disparities in the side effects experienced by patients treated with methotrexate. This information may be useful to clinicians counseling patients on risk profile.

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Background Stevens Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) are specific drug hypersensitivity reactions initiated by cytotoxic T-lymphocytes. Augmentation of T-cell activation by positive co-stimulation and Major Histocompatibility Complex-restricted presentation of the culprit drug triggers T-cell activation following interaction with T-cell receptors. This T-cell activation results in expression of cytokines including TNF-α, interferon-γ, granzyme B and granulysin from NK cells. Besides their role in causing SJS/TEN, these cytokines cause coagulation activation. Materials & Methods Following an Institutional Review Board approved protocol blood samples were obtained from subjects suspected of SJS/TEN and normal healthy volunteers (n=2). Confirmatory biopsies were performed in all SJS/TEN subjects which confirmed SJS/TEN in 4 subjects and were negative in 7 subjects. Cytokine levels were measured using the cerebral II array biochip from Randox Laboratories Limited (Crumlin, UK). Besides cerebral array II, other parameters such as thrombin-antithrombin (TAT) complexes (Dade®, Marburg, Germany), fibrinopeptide A (F1.2, Dade®), plasminogen activator inhibitor-1 (PAI-1, Diagnostica Stago® and STACHROME antithrombin (Stago®), ZYMUPHEN platelet microparticles activity (Hyphen® Biomed (Neuville-sur-Oise, France), and HEMOCLOT protein C (Stago®) were measured using ELISA kits as per manufacturers’ instructions. Results Compared to the Normal Human Plasma, the IL-4, IL-6, TNF-α, and MCP-1 levels were increased significantly in biopsy-confirmed SJS/TEN patients (see table). Other parameters measured including IL-2, IL-8, IL-10, VEGF, INF-γ, IL-1α, IL1-β and EGF were not significantly increased. A marked increase in the TAT complexes (6.3±5.9 µg/ml), F1.2 (430.4±202.4 pmol/L), platelet microparticles (13.1±9.3 nM) and protein C levels (90.5±63.4%) with a corresponding decrease in PAI-1 (53.3±18.8ng/ml) and antithrombin levels (80.7±42.4%) compared to normal human plasma were also observed. Biopsy-negative SJS/TEN subjects with less pronounced inflammatory stimulus, demonstrated mild elevation in cytokine levels of IL-4 (1.95±0.59 pg/ml), IL-6 (29.81±25.18 pg/ml), TNF-α (7.20±5.04 pg/ml) and MCP-1 (265.10±159.09 pg/ml)). Conclusions T-cell activation and release of cytokines especially TNF-α and granzyme B causes immune-mediated activation of coagulation with increase in TAT, MCP-1, F1.2 and platelet microparticles and corresponding decrease of protein C, antithrombin, and PAI-1. These alterations in coagulation may progress to sepsis associated coagulopathy and overt disseminated intravascular coagulation. Disclosures: No relevant conflicts of interest to declare.

An 18-year-old female who was 14 weeks pregnant first noted vision loss in her left eye six days prior to admission. Ophthalmologic examination revealed 20/20 vision in the right eye and count fingers vision in the left eye. A marked relative afferent pupillary defect was present in the left eye. Ophthalmoscopic examination revealed a trace optic nerve pallor temporally in the left eye without associated disc oedema or haemorrhage. Magnetic resonance imaging of the brain demonstrated a heterogeneous mass of the left sphenoid sinus extending superiorly causing compression of the intracranial portion of the left optic nerve, and laterally into the left cavernous sinus. The patient underwent transphenoidal resection of the tumour whose histologic morphology revealed a grade 2 osteosarcoma. Following resection, vision returned to 20/20 in the left eye. The patient has been treated with chemotherapy with close monitoring of her pregnancy.