Abstract
Purpose :
Coccidioidomycosis is an infection caused by the dimorphic Coccidioides fungus. Coccidioides is endemic to the Southwest United States, including New Mexico, Arizona, Utah, Nevada, and the San Joaquin Valley of California. An estimated 150,000 new cases of coccidioidomycosis occur in the US annually, and the incidence is increasing. Fewer than 1% of patients experience disseminated disease, with ocular involvement occurring in roughly 0.5% of cases. Ocular coccidioidomycosis presents a diagnostic challenge given its rarity and variable presentation, but it may severely compromise vision if not promptly addressed. We seek to evaluate the clinical features of coccidioidomycosis with ocular involvement.
Methods :
We performed an exhaustive search of PubMed and the Cochrane Library from 1980 until November 2019 for cases of ocular coccidioidomycosis in humans. Data collected and analyzed included patient demographics, exposure history, lesion type, laterality, immune status, systemic involvement, presenting symptoms, ophthalmic findings, diagnostic workup, serology and culture results, ocular therapies, systemic therapies, and surgical interventions.
Results :
Twenty cases of ocular coccidioidomycosis were identified. Eighteen had known history of exposure to endemic areas. The average patient age was 42.9 years (range 10-77, median 42). Ocular manifestations were diverse, resulting in chorioretinitis (8), endophthalmitis (5), iritis (4), cutaneous lesions (2), conjunctivitis (1), and iridocyclitis (1). Where immune status was reported, 54% of cases involved an immunocompetent individual. 75% of cases were unilateral. In 86% of cases, there were preceding ocular symptoms prior to diagnosis. In 81% of cases, there were preceding systemic symptoms such as fever or pneumonia. Patients were treated with a combination of systemic antifungals, intravitreal antifungals, topical antifungals, oral azoles, and ocular surgery. In 53% of cases, final visual acuity was Count Fingers or worse, including four enucleations and one death.
Conclusions :
Ocular coccidioidomycosis is rare, with 20 cases reported in the past 40 years. However, severe loss of vision has been reported in up to 53% of these cases. It may be seen in younger individuals regardless of immune status. Diagnosis can be challenging given the range of presentations. Providers should consider coccidioidomycosis in patients with exposure to endemic areas and unexplained ocular inflammation.
This is a 2020 ARVO Annual Meeting abstract.