Aspergillus fumigatus scleritis associated with monoclonal gammopathy of undetermined significance.
A 68-year-old woman presented with pain in her left eye. Necrosis with calcium plaques was observed on the medial part of the sclera. Aspergillus fumigatus was isolated from the culture of the necrotic area. On systemic work-up including serum and urine electrophoresis studies, the serum monoclonal protein of immunoglobulin G was detected. The patient was diagnosed with monoclonal gammopathy of undetermined significance and fungal scleritis. Despite intensive treatment with topical and oral antifungal agents, scleral inflammation and ulceration progressed, and scleral perforation and endophthalmitis developed. Debridement, antifungal irrigation, and tectonic scleral grafting were performed. The patient underwent a combined pars plana vitrectomy with an intravitreal injection of an antifungal agent. However, scleral and intraocular inflammation progressed, and the eye was enucleated. Aspergillus fumigatus was isolated from the cultures of the eviscerated materials. Giemsa staining of the excised sclera showed numerous fungal hyphae.
Jo
Dong Hyun
DH
Department of Ophthalmology, Seoul National University College of Medicine, #28 Yeongeon-dong, Jongno-gu, Seoul, Korea.
Oh
Joo Youn
JY
Kim
Mee Kum
MK
Heo
Jang Won
JW
Lee
Jin Hak
JH
Wee
Won Ryang
WR
D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D001228:Aspergillosis / Q000628:therapy; D001232:Aspergillus fumigatus; D018450:Disease Progression; D015353:Eye Enucleation; D005260:Female; D006801:Humans; D056965:Injections, Intraocular; D010265:Paraproteinemias / Q000150:complications*; D012590:Sclera / Q000000981:diagnostic imaging / Q000473:pathology; D015423:Scleritis / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology; D014463:Ultrasonography; D014821:Vitrectomy
D000935:Antifungal Agents; D000666:Amphotericin B