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Remarkable case of early Aspergillus endophthalmitis
1Eye Pathology Laboratory, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA. gwollens@http://www.hotmail.com
Background:
This case demonstrates the early stage of Aspergillus endophthalmitis and is the second ultrastructural study of endogenous Aspergillus endophthalmitis. It is the first description of phagocytosis of Aspergillus fungi by retinal pigment epithelium (RPE).
Methods:
A case report and detailed light- and electron microscopic findings are presented.
Results:
Histopathological examination of serial sections of the affected right eye displayed a spread of Aspergillus fumigatus fungi along two separate paths: via the retinal and choroidal vessels. The retinal and choroidal lesions were not contiguous. The organisms penetrated blood vessel walls, Bruch's membrane and the internal limiting membrane, but not the RPE layer. A curious accumulation of the Aspergillus fungi was present on the internal aspect of Bruch's membrane, where the RPE acted as a barrier and the subretinal space was not invaded. Phagocytosis of fungi by the RPE was observed. No inflammatory cells were present between Bruch's membrane and the RPE.
Conclusions:
This report describes a remarkable barrier function, possible local immunosuppression and phagocytosis by the RPE cells in a case of early Aspergillus endophthalmitis.