We present three cases of Aspergillus endogenous endophthalmitis in immunocompromised patients. Case 1 is a 56 year old man with emphysema who developed endogenous Aspergillus endophthalmitis after brief treatment with corticosteroids.The eye required enucleation. Case 2 is a 57 year old woman with bronchiolitis obliterans organizing pneumonia (BOOP) treated with corticosteroids who had Aspergillus endocarditis and endogenous Aspergillus endophthalmitis. She died of a cerebral hemorrhage. Case 3 is a 73 year old man with BOOP on corticosteroids who developed invasive pulmonary aspergillosis with dissemination to the eye. In an effort to define better ways to identify patients at risk for Aspergillus endogenous endophthalmitis and to determine optimal diagnostic and treatment strategies, we reviewed 86 cases of endogenous Aspergillus endophthalmitis reported since 1949. Predisposing medical conditions were present in 94%. Immunosuppression including organ transplantation, steroids, or malignancy was present in 49%, intravenous drug use was noted in 27%, and underlying lung disease in 17%. Pars plana vitrectomy appears to be the highest-yield procedure for establishing the diagnosis. 90% of vitrectomy specimens yielded Aspergillus compared with 54% of vitreous aspirates. A. fumigatus caused infection in 51% and A. JEavus in 26%. Outcomes were generally poor. Only 7 of the 84 patients (8%) with posterior chamber involvement regained useful vision. Treatment with intravenous amphotericin B combined with intravitreal injection of amphotericin B and vitrectomy appears to be the most efficacious therapy. Six of 7 patients reported to have regained useful vision had received such treatment. Aspergillus endogenous endophthalmitis is difficult to diagnose and treat effectively. The best strategy appears to include diagnostic vitrectomy in high-risk individuals combined with intravitreal and systemic amphotericin B for patients in whom Aspergillus spp. are identified.
Full conference title:
12th International Symposium on Infections in the Immunocompromised Host
- ISIIH 12th