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[Mycotic retrobulbar neuritis]
Background:
Fungal disease is one of the most common complications of malignant haematologic disease. In the major part of the patients the lungs and the gastrointestinal tract are affected. Infections of the eyes and adnexa are very rare.
Patient And Methods:
A 75-year-old woman presented with acute unilateral loss of vision. The history revealed an anaplastic anemia. Vision of the affected eye decreased to light perception. The ophthalmoscopic findings were normal. A retrobulbar tumor was diagnosed by ultrasonography and CT. It was regarded as a glioma or a meningioma. A Non-Hodgkin lymphoma of low malignancy was proven by biopsy of bone marrow; hence a retrobulbar lymphoma was included in the differential diagnosis. Radiation was started, but the general state of health worsened and the patient died. AUTOPSY FINDINGS: A severe mycotic infiltration of the left optic nerve sheath was found, which had broadened the spatium intervaginale. Cause of death was a pneumonia by generalized immunocytoma.
Conclusions:
In cases with retrobulbar tumors and malignant haematologic diseases fungal infections should be included in the differential diagnosis. Serologic investigations are useful. The prognosis is poor and depends on the course of the basic disease.
Insights
Fungal infections are rare causes of vision loss in patients with hematologic malignancies. This case highlights a fatal retrobulbar fungal infection mimicking a tumor in a patient with anaplastic anemia.
Area of Science:
- Ophthalmology
- Hematology
- Mycology
Background:
- Fungal infections are common in patients with hematologic malignancies, typically affecting the lungs and gastrointestinal tract.
- Ocular and adnexal fungal infections are exceptionally rare complications.
Observation:
- A 75-year-old woman with anaplastic anemia experienced acute, unilateral vision loss.
- Initial diagnosis suggested a retrobulbar tumor (glioma, meningioma, or lymphoma) based on imaging.
- Despite treatment, her condition worsened, leading to death.
Findings:
- Autopsy revealed severe mycotic infiltration of the optic nerve sheath, causing significant swelling.
- The patient's death was attributed to pneumonia secondary to generalized immunocytoma.
Implications:
- Fungal infections should be considered in the differential diagnosis of retrobulbar masses in patients with hematologic diseases.
- Serologic tests can aid in diagnosis.
- Prognosis is poor and linked to the underlying hematologic condition.