Necrotizing Choroiditis-Retinitis as Presenting Symptom of Disseminated Aspergillosis after Lung Transplantation

Abstract

Aspergillus endopthalmitis may occur in patients undergoing lung transplantation despite antifungal therapy. Increased awareness of this unusual entity may be life and vision saving in these patients.

Endogenous Aspergillus Endophthalmitis Masquerading As Temporal Arteritis and Acute Retinal Necrosis

“…Although ophthalmic aspergillosis is not a well-known masquerader of either temporal arteritis or ARN, it seems that a small but recurring number of patients present with features of headache, chorioretinal vascular occlusions, or a viral retinitisY like clinical picture. 16 In a larger series of EAE, 8 2 of 16 patients developed temporal chorioretinal lesions similar to this case, whereas most (8/12) had central macular lesions. 13 Additionally, an ARN-like clinical picture was reported in 12.5% of 16 predominantly immunocompromised patients who were initially treated for viral retinitis but were found to have other diagnoses.…”

Endogenous Bacterial and Fungal Endophthalmitis

“…Other isolates from EFE are rare and are reported as individual cases. [21][22][23][24][25] 27 identified systemic fungal involvement in a patient group that had an 18% rate of culture proven fungemia while alive. Clearly, suspicion of EFE should be maintained even in the absence of laboratory support for the diagnosis.…”

Fungal and Parasitic Infections of the Eye

“…Endophthalmitis, therefore, is the sole manifestation of disseminated disease and must be established by aspiration of the vitreous (281). Aspergillus endophthalmitis has also arisen in recipients of solid-organ transplants, in which the donated organ was the likely source of the fungus (16,139). Pathologic specimens of invasive aspergillosis usually demonstrate angioinvasion by the hyphae, and thus Aspergillus species may possess a tropism for vascular tissue (279).…”