Disseminated Sporotrichosis with Intraocular Involvement

To report a rare case of intraocular sporotrichosis in a patient with disseminated sporotrichosis and a consumptive syndrome possibly secondary to multiple myeloma.

Case report.

A 55-year-old male patient with consumptive syndrome and a history of alcoholism presented to the uveitis clinic complaining of decreased visual acuity in the right eye (RE), accompanied by ocular pain and hyperemia. He had disseminated sporotrichosis and was undergoing treatment with itraconazole 400 mg/day. Ophthalmologic examination revealed visual acuity of light perception in the RE and 20/30 in the left eye (LE). Slit-lamp biomicroscopy of the RE showed granulomatous keratic precipitates, cells 4+, flare 3+, posterior synechiae, cataract, and a round, yellowish-white lesion in the temporal region of the anterior chamber. Fundoscopy of the RE was not possible due to media opacity, and ultrasonography suggested a vitreous inflammatory process. Aqueous humor culture tested positive for Sporothrix sp. Intracameral and intravitreal injections of amphotericin B were administered, followed by phacoemulsification without intraocular lens implantation, combined with pars plana vitrectomy and an additional intravitreal injection of amphotericin B. At follow-up, visual acuity improved to 20/60, with a reduction of inflammation. The patient remains under investigation for multiple myeloma.

Rare manifestations of intraocular sporotrichosis highlight the need to investigate underlying  immunosuppression.