title: Endogenous Histoplasma capsulatum endophthalmitis in an immunocompetent patient.
abstract: OBJECTIVE
  To report on a case of Histoplasma capsulatum endogenous endophthalmitis in an immunocompetent patient.
  
  
  METHODS
  A 30-year-old patient was admitted with floaters and vision impairment of 1 month's duration. He had a history of adrenal insufficiency, together with nasal, septum, and soft palate lesions of 3 months; duration. Culture results from specimens of these lesions were positive for H capsulatum. He was human immunodeficiency virus negative and there was no evidence of immunodepression or history of immunosuppression. Fundus examination revealed multiple fluffy balls with a string of pearls appearance, 2+ vitreous haze, multiple foci of retinochoroiditis inferiorly in the peripheral retina, and a 6-disk area lesion of retinochoroiditis at the superotemporal periphery. Due to poor response to oral itraconazole, a vitrectomy was performed with an intraocular injection of amphotericin B 5 μg/0.1 mL and removal for a vitreous specimen for culture of bacteria and fungi.
  
  
  RESULTS
  Vitreous specimen culture of the yeast at 28°C grew a white filamentous fungus colony, which was again cultured in a brain heart infusion agar medium, where it developed hyaline septate hyphae with microconidia and circular macroconidia with double wall, which was stained with a lactophenol dye at microscopic examination. The macroscopic morphology was consistent with H capsulatum.
  
  
  CONCLUSIONS
  Although endogenous H capsulatum endophthalmitis is a rare entity, it should be considered as a possible etiology even in apparently immunocompetent hosts, especially in patients with history of disseminated disease.
authors.affiliation: 1 Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires - Argentina.
authors.forename: Ariel
authors.initials: A
authors.lastname: Schlaen
authors.forename: Mariana
authors.initials: M
authors.lastname: Ingolotti
authors.forename: Cristobal
authors.initials: C
authors.lastname: Couto
authors.forename: Nestor
authors.initials: N
authors.lastname: Jacob
authors.forename: Gloria
authors.initials: G
authors.lastname: Pineda
authors.forename: Mario
authors.initials: M
authors.lastname: Saravia
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002825:Chorioretinitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy; D003131:Combined Modality Therapy; D009877:Endophthalmitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D006658:Histoplasma / Q000302:isolation & purification*; D006660:Histoplasmosis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D007121:Immunocompetence; D016867:Immunocompromised Host; D056965:Injections, Intraocular; D008297:Male; D014821:Vitrectomy; D014822:Vitreous Body / Q000473:pathology
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B