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HISTOPLASMA CAPSULATUM PACEMAKER-RELATED ENDOCARDITIS PRESENTING AS ENDOGENOUS ENDOPHTHALMITIS

Cindy Chen1, Jose A Morillas2, Susan J Rehm2

  • 1Cleveland Clinic Cole Eye Institute, Cleveland, Ohio.

Retinal Cases & Brief Reports
|February 2, 2023
PubMed
Abstract

Insights

This case report details a rare instance of pacemaker-related infective endocarditis caused by Histoplasma capsulatum, leading to endogenous endophthalmitis. Early consideration of fungal causes is crucial for patients with endovascular infections.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Cardiology

Background:

  • Pacemaker-related infective endocarditis is a serious complication.
  • Endogenous endophthalmitis requires prompt diagnosis and treatment.
  • Histoplasma capsulatum is an endemic fungus that can cause systemic infections.

Observation:

  • A 75-year-old male presented with vision loss and ocular inflammation.
  • Blood and vitreous cultures were negative for bacteria, but fungal DNA (Histoplasma capsulatum) was detected in vitreous fluid.
  • Histopathology and PCR of the pacemaker lead confirmed Histoplasma capsulatum.

Findings:

  • The patient had pacemaker-related infective endocarditis manifesting as endogenous endophthalmitis.
  • Histoplasma capsulatum was identified as the causative agent.
  • Despite treatment, the ocular condition progressed to phthisis.

Implications:

  • Histoplasma capsulatum should be considered in the differential diagnosis of endogenous endophthalmitis, especially in endemic areas.
  • This case highlights the importance of a multidisciplinary approach in managing complex infections.
  • Early identification and treatment of fungal endocarditis can potentially improve patient outcomes.

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