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Coccidioidomycosis with necrotizing granulomatous conjunctivitis
L J Maguire1, R J Campbell, R S Edson
1Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905.
Cornea
|November 1, 1994
Summary
Severe necrotizing granulomatous conjunctivitis caused by Coccidioides immitis was treated successfully with aggressive debridement and antifungal therapy. Ocular involvement in pulmonary coccidioidomycosis may be underestimated, especially in immunocompromised patients.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Steroid-resistant conjunctival nodules can be challenging to manage.
- Aggressive immunosuppression can unmask or exacerbate latent infections.
- Coccidioides immitis is a fungal pathogen endemic to specific regions.
Observation:
- A patient presented with severe necrotizing granulomatous conjunctivitis unresponsive to steroids.
- Infection with Coccidioides immitis was confirmed in conjunctival and lung tissue.
- A cavitary lesion was identified on chest radiography.
Findings:
- The conjunctival nodule evolved into severe necrotizing granulomatous conjunctivitis under aggressive steroid treatment.
- Coccidioides immitis was identified as the causative agent of the ocular and pulmonary disease.
- Successful treatment required surgical debridement and prolonged antifungal therapy with amphotericin B and fluconazole.
Implications:
- Subclinical ocular involvement in pulmonary coccidioidomycosis may be more prevalent than recognized.
- Immunocompromised states increase the risk of clinically significant ocular coccidioidomycosis.
- Early diagnosis and aggressive combined therapy are crucial for managing severe ocular fungal infections.