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Fungal endophthalmitis in a case of granulomatosis with polyangitis

Ghadah Mohammed S AlQahtani1, Alaa Adher D AlSayed1, Shiji Gangadharan2

  • 1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Saudi Journal of Ophthalmology : Official Journal of the Saudi Ophthalmological Society
|September 19, 2018
PubMed

Insights

This case highlights a rare Aspergillus fumigatus infection presenting as a brain abscess and endophthalmitis in an immunocompromised patient with granulomatosis with polyangitis (GPA). Despite aggressive treatment, vision loss occurred due to severe retinal damage.

Area of Science:

  • Infectious Diseases
  • Ophthalmology
  • Neurology

Background:

  • Immunocompromised individuals, particularly those with granulomatosis with polyangitis (GPA), are susceptible to opportunistic infections.
  • Fungal brain abscesses and subsequent endophthalmitis are rare but severe complications.

Purpose of the Study:

  • To report a case of Aspergillus fumigatus infection manifesting as a brain abscess and endophthalmitis.
  • To discuss the diagnostic challenges and management of this rare clinical presentation.

Main Methods:

  • Case report of a 70-year-old male with GPA and comorbidities.
  • Diagnosis involved neuroimaging, ophthalmological examination, and microbiological cultures.
  • Treatment included surgical drainage, antifungal therapy, and pars plana vitrectomy.

Main Results:

  • Cultures from brain abscess pus and vitreous specimen confirmed Aspergillus fumigatus.
  • Ophthalmological findings included anterior chamber inflammation, vitreous haze, and hemorrhagic chorioretinitis with severe vasculitis.
  • Despite treatment, the patient experienced progressive vision loss in the affected eye.

Conclusions:

  • Aspergillus fumigatus can cause severe, disseminated infections in immunocompromised patients.
  • Early recognition and multidisciplinary management are crucial, though visual prognosis can be poor.
  • This case underscores the importance of considering fungal infections in immunocompromised patients with neurological and ophthalmological symptoms.
Keywords:
Aspergillus fumigatusEndogenous endophthalmitisFungal endophthalmitisGPAGranulomatosis with polyangitisWegener’s granulomatosis

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