Involvement of intraocular structures in disseminated histoplasmosis.
OBJECTIVE
To describe ocular involvement and response to treatment in a patient with human immunodeficiency virus (HIV) infection with severe progressive disseminated histoplasmosis (PDH).


METHODS
We report a 35-year-old HIV-infected patient seen in our clinics over a period of 4 years. During antiretroviral treatment (ART), the HIV load became undetectable at 3 months; however, CD4 T-cell count increased slowly and rose to 100 cells/microl. Histoplasma capsulatum was cultured from skin pustules, cerebrospinal fluid (CF) and aqueous humour.


RESULTS
The patient developed central nervous system (CNS) involvement 2 months and panuveitis in both eyes 4 months after the initiation of ART. With intravenous liposomal amphotericin B followed by oral voricanozole, the chorioretinal lesions of the right eye (RE) became inactivated and magnetic resonance imaging (MRI) lesions of CNS disappeared. Relapse of the inflammation in the anterior segment of the left eye (LE) resulted in a total closure of the chamber angle and severe glaucoma. Despite medical therapy, two cyclophotocoagulations, total vitrectomy and repeated intravitreal amphotericin B injections, LE became blind. Histoplasma capsulatum was cultured from the aqueous humour after antifungal therapy of 16 months' duration.


CONCLUSIONS
PDH with intraocular and CNS manifestations was probably manifested by an enhanced immune response against a previous subclinical disseminated infection. It seems difficult to eradicate H. capsulatum from the anterior segment of the eye in an immunocompromised patient.
Ala-Kauhaluoma
Marianne
M
Department of Ophthalmology, Helsinki University Central Hospital, Finland. marianne.ala-kauhaluoma@fimnet.fi
Aho
Inka
I
Ristola
Matti
M
Karma
Anni
A
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000382:microbiology; D018791:CD4 Lymphocyte Count; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D002555:Cerebrospinal Fluid / Q000382:microbiology; D003881:Dermatomycoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D004359:Drug Therapy, Combination; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015497:HIV-1 / Q000502:physiology; D006658:Histoplasma / Q000302:isolation & purification*; D006660:Histoplasmosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D015864:Panuveitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012867:Skin / Q000382:microbiology; D019562:Viral Load
D044966:Anti-Retroviral Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B