Chorioretinal involvement in a patient with paracoccidioidomycosis: a case report

Paracoccidioidomycosis is a systemic fungal infection endemic to Latin America, with limited reports of ocular involvement. This case is unique for presenting chorioretinal lesions without vision loss, highlighting the importance of ophthalmologic evaluation in patients diagnosed with Paracoccidioidomycosis. Early antifungal treatment is crucial for preventing severe outcomes.

A 58-year-old male, previously diagnosed with Paracoccidioidomycosis through a skin biopsy, presented with palpebral lesions and mild keratitis in the right eye (OD) and chorioretinal lesions in the left eye (OS) upon fundoscopic examination. Optical coherence tomography (OCT) of macula revealed characteristic chorioretinal lesions in the OS, indicative of a fungal infection. Despite the ocular findings, visual acuity remained unaffected. Diagnosis was established based on the patient's medical history of fungal infection, epidemiology, and ophthalmological findings. The patient was treated with systemic Amphotericin B followed by sulfamethoxazole-trimethoprim that resulted in notable improvements either in the palpebral cutaneous lesions of the OD and the chorioretinal lesion observed in OS.

This case highlights the critical role of ophthalmologic evaluation in diagnosing and managing rare complications of systemic paracoccidioidomycosis. Early intervention with appropriate systemic antifungal therapy can significantly improve outcomes, preserving vision and mitigating systemic complications. Enhanced awareness among clinicians in endemic areas is essential for timely diagnosis and management.