Bilateral endogenous necrotizing scleritis due to Aspergillus oryzae

Area of Science:

• Ophthalmology
• Mycology
• Infectious Diseases

Background:

• Endogenous fungal infections can manifest in the eye, posing significant diagnostic and therapeutic challenges.
• Aspergillus species are known pathogens, but Aspergillus oryzae is rarely implicated in human disease, particularly ocular infections.

Observation:

• A former intravenous drug user presented with bilateral necrotizing scleritis.
• A remote seeding focus in the thoracic spine was identified as the source of infection.
• The patient had a prior history of meningitis caused by Aspergillus oryzae.

Findings:

• This case represents the first reported instance of ocular disease caused by Aspergillus oryzae.
• The patient experienced successful treatment with a combination of local and systemic antifungal agents, including amphotericin B, flucytosine, and natamycin.
• This is also the first reported case of isolated scleral, non-intraocular involvement in endogenous oculomycosis.

Implications:

• Highlights the potential for rare Aspergillus species to cause severe ocular disease.
• Demonstrates the efficacy of combined antifungal therapy in managing complex endogenous fungal scleritis.
• Emphasizes the importance of considering fungal infections in immunocompromised patients with unexplained ocular inflammation.