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The diagnostic value of fungal autofluorescence
Abstract:
Many pathogenic and saprophytic fungi fluoresce under ultraviolet light. Autofluorescence usually persists even if the specimen has undergone fixation, paraffin embedding, and staining with hematoxylin and eosin. Thus, fluorescence microscopy can help to identify organisms in histopathologic sections of ocular and periocular tissue. It may reveal microorganisms that do not stain with hematoxylin and eosin, and it does not alter or adversely affect microscopic sections. We describe a case of periocular cutaneous blastomycosis which was misdiagnosed clinically and histologically as squamous cell carcinoma. Fluorescence microscopy of the initial hematoxylin and eosin stained section revealed microorganisms that were not appreciated on the first skin biopsy.
Insights
Autofluorescence microscopy aids in identifying fungi in tissue. This technique revealed fungal organisms missed in a periocular blastomycosis case initially misdiagnosed as squamous cell carcinoma.
Area of Science:
- Medical Mycology
- Histopathology
- Ophthalmology
Background:
- Fungal infections can affect ocular and periocular tissues.
- Standard histopathology may miss certain fungal elements.
- Autofluorescence is a property of many fungi.
Purpose of the Study:
- To highlight the utility of fluorescence microscopy in diagnosing fungal infections.
- To report a case of periocular blastomycosis misdiagnosed clinically and histologically.
- To demonstrate how autofluorescence can reveal fungal organisms missed by conventional staining.
Main Methods:
- Review of a case of periocular cutaneous blastomycosis.
- Clinical and histological examination of skin biopsy.
- Application of fluorescence microscopy to hematoxylin and eosin stained sections.
Main Results:
- Autofluorescence microscopy identified fungal microorganisms not initially detected.
- The case was initially misdiagnosed as squamous cell carcinoma.
- Fluorescence microscopy confirmed the presence of Blastomyces in the biopsy.
Conclusions:
- Fluorescence microscopy is a valuable tool for identifying fungal pathogens in histopathologic specimens.
- Autofluorescence can improve the diagnostic accuracy of fungal infections, especially when conventional methods fail.
- This technique can prevent misdiagnosis and guide appropriate treatment for fungal diseases.