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B. A. Schlaen, M. J. Saravia, N. Jacob, G. Pineda; Endogenous Endophthalmitis by Histoplasma Capsulatum in an Immunocompetent Patient. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6046.
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To present a case of endogenous endophthalmitis caused by Histoplasma Capsulatum in an immunocompetent patient
A 30-year-old patient, whose chief complaints were floaters and visual acuity impairment of 1 month duration in OD was admitted in our consultation. He had a history of adrenal insufficiency, together with nasal, septum and soft palate lesions of 3 month duration which were followed by the infectology department. Cultures results from specimens of these lesions were positive for Histoplasma Capsulatum, and itraconazole 400mg/day PO was administered. He was HIV negative and there was neither evidence of immunodepression nor history of immunosuppression.At examination, best corrected visual acuity was 20/30 and 20/20 in OD and OS, respectively. At biomicroscopy, 2+ cells and fine keratic precipitates were observed in OD, whereas OS examination was normal. Intraocular pressure was 14 mmHg in OD and 15 mmHg in OS. Fundus examination revealed multiple fluff balls with a string of pearls appearance , vitreous haze 2+, multiple foci of retinochoroiditis at inferior periphery at 6 to 8 hours, and a 6 disk area lesion of retinochoroiditis at the supero-temporal periphery (9 to 10 hours).
Due to the scarce response to oral Itraconazole, a vitrectomy was carried out with an intraocular injection of amphotericin B 5 µg/0.1 ml, and a vitreous specimen was taken out for culture of bacteria and fungi.First week after surgery, cultures were negative. Best corrected visual acuity was 20/20 in OU. Biomicroscopy revealed trace cells (3) in OD. At fundus examination, vitreous was clear, and the limits of the area of extensive retinitis became more discrete. At the second week, a non candidal yeast developed in vitreous culture at 37 degrees. Fundus examination revealed multifocal chorioretinal scars at inferior periphery (6 to 8 hours), and instead of the area of extensive retinitis there was a healed lesion. At third week, a retinal detachment secondary a nasal giant tear with macula on was observed. The patient underwent a scleral buckling procedure.Culture of the yeast at 25 degrees, developed septate hyphae with micro and macroconidia at microscopic examination, with a macroscopic morphology consistent with histoplasma capsulatum.Currently, retina is attached with a best corrected visual acuity of 20/20.
Early treatment of endogenous endophthalmitis caused by Histoplasma Capsulatum in an immunocompetent patient can result in an optimal visual outcome
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