Ocular histoplasmosis with retinitis in a patient with acquired immune deficiency syndrome

Disseminated histoplasmosis is one of the life-threatening opportunistic infections associated with acquired immune deficiency syndrome (AIDS). A 29-year-old man with AIDS and disseminated histoplasmosis complained of a hazy spot in the vision of his left eye. Results of examination showed distinct creamy white intraretinal and subretinal infiltrates in both eyes. The patient died within a month from pulmonary infection with Histoplasma capsulatum and cytomegalovirus. Examination with light microscopy showed that the right and left eyes contained histoplasma yeast cells in lesions of retinitis, optic neuritis, and uveitis. These lesions contained variable numbers of lymphocytes and histiocytes. Electron microscopy of the histoplasma in tissue showed characteristic features. This case illustrates the funduscopic appearance and histopathology of histoplasmic retinitis, an uncommon although important ophthalmologic complication of AIDS.