Coccidioidomycosis with necrotizing granulomatous conjunctivitis.
A patient with a steroid-resistant conjunctival nodule developed severe necrotizing granulomatous conjunctivitis during aggressive treatment with topical, subconjunctival, and systemic steroids. Culture of the tissue yielded Coccidioides immitis. A cavitary lesion was noted on a chest radiograph, and the same organism was recovered from a lung biopsy specimen. The granulomatous conjunctivitis was controlled only after aggressive debridement of the affected area and months of treatment with topical amphotericin B and oral fluconazole. A review of the literature suggests that subclinical ocular involvement from pulmonary coccidioidomycosis may be more common than generally believed. Conditions that blunt the host immune response may lead to a higher incidence of clinically significant ocular involvement.
Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905.
L J
LJ
Maguire
R J
RJ
Campbell
R S
RS
Edson
D000368:Aged; D003047:Coccidioidomycosis / Q000473:pathology*; D003228:Conjunctiva / Q000382:microbiology / Q000473:pathology*; D003231:Conjunctivitis / Q000382:microbiology / Q000473:pathology*; D015821:Eye Infections, Fungal / Q000382:microbiology / Q000473:pathology*; D005260:Female; D006099:Granuloma / Q000382:microbiology / Q000473:pathology; D006801:Humans; D009336:Necrosis