Paracoccidioidomycosis: Study of six cases with ocular involvement

Abstract

We present 6 patients with ocular involvement due to paracoccidioidomycosis. All cases were confirmed by the finding of Paracoccidioides brasiliensis in histopathological or direct mycologic examination of material from the lesion in the eyelid or conjunctiva. In two cases the bulbar conjunctiva was also involved, in another the cornea, and still another patient developed endophthalmitis. The presence of this mutilating disease which may lead to blindness should be suspected when chronic blepharitis or palpebral ulcerated papular lesions are detected in patients from endemic areas of paracoccidioidomycosis. This etiology should also be suspected in patients with anterior and posterior uveitis after discarding the most frequent causes of this condition.

Current Perspectives on Ophthalmic Mycoses

“…6), which has been recovered from soil and decaying vegetation in zones of endemic infection (southern Mexico and Central and South America), causes a severe, usually chronic disease with involvement of the skin, lungs, and lymphoid organs. Ocular involvement usually represents reactivated disease and commonly manifests as a chronic papular or ulcerating lesion of the eyelid in a man older than 30 years engaged in agriculture and coming from regions of endemic infection (353). (Fig.…”

“…Reported to cause lesions of eyelids (46,353), cornea (353), and bulbar conjunctiva (353); anterior uveitis (353); and granulomatous uveitis (75). Diagnosis by histopathological examination or direct microscopy of lesions (353); no photomicrographic evidence.…”

“…Diagnosis by histopathological examination or direct microscopy of lesions (353); no photomicrographic evidence. Ophthalmic lesions are rare in the absence of lesions elsewhere in the body, unless entry is through a wound; usually unilateral.…”

“…In view of these toxic effects, treatment should be reserved for patients in whom a diagnosis of mycotic infection is reasonably well substantiated; patients receiving systemic amphotericin B for ophthalmic reasons should be comanaged with an internist, who will monitor the patient for toxicity (236). Intravenous amphotericin B continues to be the treatment of choice for invasive fungal infections of the orbit (164,213,323,349); it has also been used in the treatment of endophthalmitis due to dimorphic fungi (205,215,224,253,338,357) and lesions of the eyelids, conjunctiva, and cornea caused by P. brasiliensis (353). The efficacy of intravenous amphotericin B in endophthalmitis due to dimorphic fungi is difficult to evaluate since, in many of the reports cited, posttreatment cultures were negative but the affected eyeball had to be enucleated due to other complications.…”

“…Eyelid lesions, alone or in association with corneal and conjunctival lesions, occur in more than 50% of reported cases of ocular paracoccidioidomycosis (46,353). Males, particularly those older than 30 years who are engaged in agriculture and come from an area of endemic infection seem to be at greatest risk (353).…”