RESUMO
OBJECTIVE: To describe the clinical and histopathologic findings of a unique case of isolated optic nerve Blastomyces dermatitidis infection and to summarize the ophthalmic blastomycosis literature. DESIGN: Case report and systematic literature review. METHODS: A 70-year-old healthy man experienced impaired vision in his left eye. Magnetic resonance imaging (MRI) showed an enhancing process of the left optic nerve sheath. Although vision initially improved with oral dexamethasone, visual acuity subsequently decreased from 20/25 to no light perception over 8 weeks. An optic nerve biopsy revealed blastomycosis. Because ophthalmic blastomycosis infections are unusual, the Cochrane Library, PubMed, OVID, and UpToDate databases were searched using the term blastomycosis with the limits English and humans. Articles that predated the databases were gathered from current references. MAIN OUTCOME MEASURES: Visual acuity of the left eye and MRI of the orbits and brain. RESULTS: Histopathologic examination of the nerve specimen showed B. dermatitidis infection. Needle biopsy and culture results of a suspicious lung scar were positive for Blastomyces. The patient was treated with intravenous amphotericin B followed by oral itraconazole for 6 months. The left eye remained blind 23 months after the biopsy. Approximately 40 articles describing ophthalmic infection were found in the literature search. CONCLUSIONS: Ophthalmic blastomycosis infections can cause rapid, complete vision loss. Prompt treatment is required, but infections are uncommon and usually are misdiagnosed, often because of lack of biopsy results. Tissue must be biopsied, cultured, or both for a definitive diagnosis. Because virtually all blastomycosis cases begin in the lungs, a chest radiograph or computed tomographic scan should be obtained. Any questionable lung lesion should be biopsied to corroborate possible ophthalmic disease.
Assuntos
Blastomyces/isolamento & purificação , Blastomicose/microbiologia , Infecções Oculares Fúngicas/microbiologia , Doenças do Nervo Óptico/microbiologia , Administração Oral , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Biópsia , Blastomicose/diagnóstico , Blastomicose/tratamento farmacológico , Quimioterapia Combinada , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/tratamento farmacológico , Humanos , Infusões Intravenosas , Itraconazol/uso terapêutico , Imageamento por Ressonância Magnética , Masculino , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/tratamento farmacológico , Transtornos da Visão/diagnóstico , Transtornos da Visão/tratamento farmacológico , Transtornos da Visão/microbiologia , Acuidade Visual , Campos VisuaisAssuntos
Aspergilose/diagnóstico , Infecções Oculares Fúngicas/diagnóstico , Doenças Orbitárias/diagnóstico , Síndrome de Tolosa-Hunt/diagnóstico , Idoso , Aspergilose/microbiologia , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/microbiologia , Artéria Carótida Interna/patologia , Causas de Morte , Diagnóstico Diferencial , Infecções Oculares Fúngicas/microbiologia , Evolução Fatal , Feminino , Humanos , Imageamento por Ressonância Magnética , Artéria Oftálmica/patologia , Doenças Orbitárias/microbiologia , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/microbiologia , Síndrome de Tolosa-Hunt/microbiologia , Campos VisuaisRESUMO
We describe a man presenting with bilateral loss of vision secondary to a branch retinal artery occlusion and ischemic optic neuropathy, in turn related to underlying Wegener granulomatosis (WG). This case is unusual, because the simultaneous development of branch retinal artery occlusion and anterior ischemic optic neuropathy has, to our knowledge, not been reported in WG. Furthermore, only rarely does WG cause bilateral vision loss. The patient responded to immunosuppressive therapy and recovered sufficient vision to resume his vocation as a farmer.