Retinal involvement of Paracoccioidomycosis: A Case Report

Abstract

Purpose: to describe the clinicopathologic features and treatment of a rare case of systemic paracoccidioidomycosis with choroidal and retinal involvement. Design: retrospective interventional case report. Participant: A 36-year-old young man with visual impairment in left eye with anterior uveitis and presence of whitish perimacular choroidal nodule, multiple underlying whitish spots and mid-periphery exudative retinal detachment. A primary extensive work-up for systemic infectious, autoimmune, neoplasic or inflammatory conditions was performed and high-resolution computer tomography scan demonstrated asymmetric parietal thickening of the trachea and bilateral diffuse multiple lobular opacities. Pulmonary bronchoscopy/biopsy of larynx, trachea and bronchial tube were also performed. Histopathological evaluation showed characteristic of Paracoccidioidomycosis. Intervention: Patient was treated with oral sulphadiazine (1.5 g/day). Main Outcome Measures: Anterior uveitis, retinal examination, histopathological evaluation and primary clinical outcome were observed during systemic treatment. Results: After 3 months of irregular treatment, choroidal lesions decreased in size forming atrophic scars and fibrotic spots; however visual acuity did not show any improvement. Conclusion: We report a rare case of systemic paracoccidioidomycosis with choroidal and retinal involvement treated with oral sulphadiazine.

Prevalence and causes of clinically detectable uveitic serous retinal detachment

“…Six of the 15 patients (40.0%) with idiopathic or indeterminant disease had bilateral SRD. Of Behcet's disease 8,9 Cat scatch disease *10,11 Herpetic necrotizing retinitis (HSV, HZV, CMV) 12,13 Inflammatory bowel disease 14,15 Lyme disease 16,17 Posterior scleritis 18,19 Sympathetic ophthalmia Diffuse unilateral subacute neuroretinitis (DUSN) 35,36 H1N1 influenza vaccination 37 Hepatitis, chronic **2,38 HLA-B27-associated uveitis 39,40 Intraocular lymphoma ***41,42 Juvenile idiopathic arthritis 43,44 Paracoccioidomycosis 45 Pars planitis (peripheral) 46,47 Pneumocystis jiroveci infection 48 Sarcoidosis 49,50 Serpiginous choroiditis 51,52 Subacute sclerosing panencephalitis (SSPE) 53 Toxocariasis 54 Toxoplasmosis 55,56 Typhoid fever 57 The demographics of the VKH and idiopathic or indeterminant disease groups are summarized in Table 3.…”