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Endogenous Fusarium endophthalmitis in a patient with acute lymphocytic leukemia
A S Patel1, R K Hemady, M Rodrigues
1Department of Ophthalmology, University of Maryland Hospital, Baltimore 21201.
Abstract:
Endogenous fungal endophalmitis is an uncommon complication of systemic mycosis. Only a few cases involving Fusarium have been reported, most with unfavorable visual outcomes. We examined a 31-year-old woman with acute lymphocytic leukemia who developed sudden visual loss in her right eye. A dense, white placoid infiltrate was present in the right macula extending into the vitreous. An iris nodule and hypopyon were present in the left eye. A vitreous aspirate of the right eye was positive for Fusarium species. The patient progressively lost vision despite amphotericin B and 5-fluorocytosine therapy. She died from bronchopneumonia, fungemia, and multisystem failure. Histopathologic study disclosed a panophthalmitis with Fusarium organisms invading all the ocular coats in the right eye. Leukemic infiltrates were present in the left iris, anterior chamber, and trabecular meshwork. The ocular destructiveness of Fusarium may be caused by marked mycotic vascular invasion and occlusion with consequent infarction and necrosis of ocular tissues.
Insights
Fusarium endophthalmitis, a rare fungal infection, caused severe vision loss and death in an acute lymphocytic leukemia patient. Aggressive Fusarium invasion led to panophthalmitis and systemic complications.
Area of Science:
- Ophthalmology
- Mycology
- Hematology
Background:
- Endogenous fungal endophthalmitis is a rare but severe complication of systemic mycosis.
- Cases involving Fusarium species are infrequent, often resulting in poor visual prognoses.
Observation:
- A 31-year-old acute lymphocytic leukemia patient experienced sudden vision loss in the right eye.
- Ocular findings included a dense, white macular infiltrate, vitreous involvement, iris nodules, and hypopyon.
- Vitreous aspirate confirmed Fusarium species infection.
Findings:
- Despite treatment with amphotericin B and 5-fluorocytosine, the patient suffered progressive vision loss.
- Histopathology revealed panophthalmitis with extensive Fusarium invasion and vascular occlusion.
- The patient succumbed to bronchopneumonia, fungemia, and multisystem failure.
Implications:
- Fusarium's ocular destructiveness may stem from significant mycotic vascular invasion and occlusion.
- This case highlights the aggressive nature of Fusarium endophthalmitis in immunocompromised patients.
- Early diagnosis and aggressive management are critical for potentially improving outcomes in such cases.
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