SUBRETINAL PHIALOPHORA ABSCESS IN CHRONIC GRANULOMATOUS DISEASE
Clara M Castillejo Becerra1, Tyler M Kaplan, Rachel S Mogil
1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
Purpose:
To report a rare case of a subretinal Phialophora richardsiae abscess in a patient with chronic granulomatous disease.
Methods:
A 21-year-old man with chronic granulomatous disease and a history of invasive pulmonary aspergillosis presented with progressive loss of vision and pain in his left eye. He was found to have a subretinal abscess with a macula involving serous retinal detachment. A diagnostic and therapeutic pars plana vitrectomy, subretinal biopsy with debridement, inferior retinectomy, and silicone oil tamponade were performed. Intraoperative cultures grew Pleurostoma (Phialophora) richardsiae. He was treated with systemic liposomal amphotericin B and high-dose posaconazole. However, his eye eventually required enucleation.
Results:
Preoperative visual acuity was light perception on the left eye and improved to count fingers at 4 weeks postoperative. However, VA rapidly declined to light perception, and he developed an opaque white cataract, iris neovascularization, posterior synechiae, and corectopia. The retina remained attached under silicone oil. Histopathology revealed granuloma formation and active fungal elements.
Discussion/Conclusion:
The case supports the importance of vitreoretinal surgery to determine a definitive systemic diagnosis. Treatment of Phialophora infection is surgically challenging to manage and has a poor visual prognosis in patients with chronic granulomatous disease.
Insights
A rare subretinal Phialophora richardsiae abscess occurred in a patient with chronic granulomatous disease. Surgical management was challenging, leading to enucleation and highlighting poor visual prognosis for such fungal eye infections.
Area of Science:
- Ophthalmology
- Mycology
- Immunology
Background:
- Chronic granulomatous disease (CGD) predisposes individuals to opportunistic infections.
- Subretinal abscesses are uncommon ocular pathologies.
Observation:
- A 21-year-old male with CGD presented with vision loss and ocular pain.
- Examination revealed a subretinal abscess with macular involvement and serous retinal detachment.
- Phialophora richardsiae was identified intraoperatively.
Findings:
- Surgical intervention including vitrectomy and biopsy was performed.
- Despite antifungal treatment with liposomal amphotericin B and posaconazole, the patient's vision declined.
- The eye ultimately required enucleation due to the aggressive fungal infection.
- Histopathology confirmed granuloma formation and active fungal elements.
Implications:
- This case underscores the critical role of vitreoretinal surgery in diagnosing systemic conditions.
- Fungal infections like Phialophora in CGD patients present significant therapeutic challenges.
- Optimal management and visual outcomes remain poor for these complex cases.
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