Endophthalmitis Due to Blastomyces Dermatitidis: Case Report and Review of the Literature

doi:10.1016/S0161-6420(90)32604-0

Ophthalmology

Volume 97, Issue 2, February 1990, Pages 212-216

https://doi.org/10.1016/S0161-6420(90)32604-0 Get rights and content

Abstract

Blastomycosis very rarely affects ocular structures other than the eyelid. It is even more unusual for involvement to occur in the absence of active widespread disease. The authors report a 71-year-old woman with unresponsive endophthalmitis of the right eye who underwent enucleation. Results of microscopic examination of the globe showed severe acute and chronic granulomatous and nongranulomatous endophthalmitis as well as numerous fungi having the histologic features of Blastomyces dermatitidis. Although constitutional symptoms (weight loss, fatigue, night sweats) were noted by the patient, multiple investigations failed to disclose any evidence of systemic disease.

References (37)

FJ Bongiorno et al.
The black dot sign and North American cutaneous blastomycosis
Am J Ophthalmol
(1974)
MM Rodrigues et al.
Exogenous mycotic keratitis caused by Blastomyces dermatitidis
Am J Ophthalmol
(1973)
L Vida et al.
Systemic North American blastomycosis with orbital involvement
Am J Ophthalmol
(1974)
E Theodorides et al.
Blastomycosis of the conjunctiva
Am J Ophthalmol
(1950)
E Theodorides et al.
Blastomycosis of the conjunctiva: report of two additional cases
Am J Ophthalmol
(1953)
NC Buyukmihci et al.
Microscopic lesions of spontaneous ocular blastomycosis in dogs
J Comp Path
(1987)
PW Hiss et al.
Solitary retinovitreal abscess as the initial manifestation of cryptococcosis
Ophthalmology
(1988)
JW Rippon
Medical mycology: the pathogenic fungi and the pathogenic actinomycetes
MW Craig et al.
Conjugal blastomycosis
Am Rev Respir Dis
(1970)
ER Farber et al.
Endometrial blastomycosis acquired by sexual contact
Obstet Gynecol
(1968)

GA Sarosi et al.

Blastomycosis

Am Rev Respir Dis

(1979)

WH Wilder

Blastomycosis of the eyelid

JAMA

(1904)

CA Wood

Blastomycosis of the ocular structures, especially of the eyelids

Ann Ophthalmol (St. Louis)

(1904)

FC Blodi et al.

Cicatricial ectropion caused by cutaneous blastomycosis

Arch Ophthalmol

(1958)

CC Barr et al.

Blastomycosis of the eyelid

Arch Ophthalmol

(1986)

SH McKee

Blastomycosis of the cornea: with a review of reported cases of blastomycosis of the eye

Int Clin

(1926)

RM Sinskey et al.

Miliary blastomycosis with metastatic spread to the posterior uvea of both eyes

Arch Ophthalmol

(1955)

H Lewis et al.

Latent disseminated blastomycosis with choroidal involvement

Arch Ophthalmol

(1988)

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Case report.
A 29-year-old healthy woman with a history of pulmonary tuberculosis presented with a painful right eye and rapidly decreasing vision. Fundus examination showed a diffuse elevated choroidal lesion at the posterior pole. With an otherwise unremarkable systemic work-up, the patient was treated with systemic antibiotics and corticosteroids for a presumed diagnosis of choroidal tuberculous granuloma. After an initial response to the treatment, the patient’s condition deteriorated rapidly with visual acuity decreasing from 20/25 to no light perception in 3 months. Ipsilateral proptosis developed with magnetic resonance imaging showing a poorly defined orbital mass. Surgical enucleation and an orbital biopsy were performed.
Histopathologic examination of the orbital specimen and an intact enucleated globe showed a diffuse necrotizing granulomatous process with the presence of numerous yeasts consistent with B. dermatitidis. This subsequently was confirmed by positive culture of B. dermatitidis from the orbital specimen.
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This was the situation with our patient where changes were first documented on MRI with contrast rather than in the original CT studies. Ocular blastomycosis most frequently involves lesions of eyelid/canthal skin but endophthalmitis/panophthalmitis can occur, with or without clinically apparent preceding lung disease.19 Orbital cellulitis has also been reported.20
Blastomyces species are thermally dimorphic fungi existing as yeast in tissue. We report an initially immunocompetent patient with orbital apex syndrome (OAS) whose presentation suggested giant cell arteritis. Subsequently, metastatic carcinoma was entertained as a cause of OAS until bronchoscopy yielded Blastomyces species. The patient rapidly succumbed with multiorgan failure despite Amphotericin B administration. At post-mortem, Blastomyces co-infection with fungal hyphae in keeping with Aspergillus species was found in cavernous sinus and in infarcted optic nerve. To the best of our knowledge, co-infection with these two organisms in this clinical setting has not been reported.

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Endophthalmitis Due to Blastomyces Dermatitidis: Case Report and Review of the Literature

Abstract

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

J Comp Path

Ophthalmology

Medical mycology: the pathogenic fungi and the pathogenic actinomycetes

Conjugal blastomycosis

Am Rev Respir Dis

Endometrial blastomycosis acquired by sexual contact

Obstet Gynecol

Blastomycosis

Am Rev Respir Dis

Blastomycosis of the eyelid

JAMA

Blastomycosis of the ocular structures, especially of the eyelids

Ann Ophthalmol (St. Louis)

Cicatricial ectropion caused by cutaneous blastomycosis

Arch Ophthalmol

Blastomycosis of the eyelid

Arch Ophthalmol

Blastomycosis of the cornea: with a review of reported cases of blastomycosis of the eye

Int Clin

Miliary blastomycosis with metastatic spread to the posterior uvea of both eyes

Arch Ophthalmol

Latent disseminated blastomycosis with choroidal involvement

Arch Ophthalmol