Different presentations of ophthalmic aspergillosis.
OBJECTIVE
Aspergillus species is found worldwide and does not normally cause disease. However, when the immune system is compromised, it can invade many organs and be responsible for severe disease. The authors present cases with both classical and atypical features of ophthalmic aspergillosis.


METHODS
Case series of three patients.


RESULTS
All patients were female and had a long history of methylprednisolone use. The first two presented with endogenous endophthalmitis. One case was unilateral with a classical presentation of endophthalmitis. The other presented with a very severe bilateral acute retinal necrosis like syndrome. General work-up revealed disseminated disease in both cases. The diagnosis was made by serum immunologic testing in one case and after direct examination and culture from vitrectomy in the other. Despite intense antimycotic therapy, both patients died. The third patient presented with a unilateral progressive painful orbital apex syndrome. An orbital lesion was demonstrated by computed tomography scan and was unresponsive to methylprednisolone. Diagnosis of sino-orbital syndrome was made on biopsy. The lesion responded poorly to different antimycotic therapies, invaded the chiasma, and the patient lost all visual acuity.


CONCLUSIONS
This case series illustrates that ophthalmic aspergillosis can present acutely with a devastating intraocular inflammation or more indolently in the setting of sino-orbital aspergillosis. Both forms have a poor visual prognosis and the systemic form is frequently associated with a fatal outcome.
Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles, Bruxelles - Belgium. fwillerm@ulb.ac.be
F
F
Willermain
C
C
Bradstreet
S
S
Kampouridis
J
J
Libert
P
P
Koch
A
A
Dediste
S
S
Saussez
L
L
Caspers
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D017809:Fatal Outcome; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009916:Orbital Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D010254:Paranasal Sinus Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D011743:Pyrimidines / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole