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Posterior ischemic optic neuropathy due to Aspergillus fumigatus
J M Weinstein1, G L Morris, G M ZuRhein
1Department of Ophthalmology, University of Wisconsin, Madison.
Abstract:
A 35-year-old woman with metastatic breast cancer experienced acute monocular visual loss. Her fundus examination was normal. The patient died 48 h later, and autopsy demonstrated hematogenously disseminated aspergillosis. The retrobulbar optic nerve of the affected eye showed infarction due to massive embolization with Aspergillus fumigatus. Although the retrobulbar optic nerve is relatively resistant to ischemia, its meningeal derived blood supply may be occluded by massive showers of emboli.
Insights
Metastatic breast cancer patients can experience sudden vision loss due to invasive fungal infections. Autopsy revealed Aspergillus fumigatus emboli caused optic nerve infarction in a patient with disseminated aspergillosis.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Oncology
Background:
- Metastatic breast cancer presents complex clinical challenges, including potential opportunistic infections.
- Ocular complications in cancer patients can significantly impact quality of life and require prompt diagnosis.
Observation:
- A 35-year-old woman with metastatic breast cancer presented with acute monocular visual loss.
- Fundus examination was unremarkable, delaying diagnosis of the underlying cause.
Findings:
- Post-mortem autopsy revealed disseminated aspergillosis as the cause of death.
- Massive embolization by Aspergillus fumigatus led to infarction of the retrobulbar optic nerve.
Implications:
- This case highlights a rare but devastating cause of vision loss in immunocompromised patients.
- Ocular and neurological symptoms in cancer patients warrant thorough investigation for invasive fungal infections.
- The retrobulbar optic nerve's blood supply is vulnerable to embolic occlusion by fungal elements.