Acute presumed histoplasmosis of the optic nerve head

A 38-year-old man from the Ohio Valley area presented to the Ophthalmology Cinic at a west coast hospital (USA) because of sudden loss of the right inferior temporal visual field after severe right frontal headache of several hours' duration. During the following months, diffuse peripapillary atrophy and peripheral punched-out lesions developed. When he had been seen initially, the fundus of the left eye had also revealed extensive, diffuse, peripapillary atrophy and scarring. All laboratory tests were normal except a histoplasmin intradermal skin test. The clinical appearance of both eyes 8 months after the acute episode in the right eye supports the diagnosis of presumed ocular histoplasmosis.