[Bilateral sino-orbital mucormycosis. A case report]. / Mucormycose orbitosinusienne bilatérale. A propos d'un cas.

We report a case of mucormycosis in a 48 year-old diabetic woman. She presented with nasosinusal ulcer accompanied by panophthalmitis in the left eye and central retinal artery occlusion in the right eye. Left eye enucleation was performed and the diagnosis of mucormycosis was made on histopathologic examination displaying fungal micro-organisms in the optic nerve and in the retina. The patient died of stress ulcer hemorrhage. Mucormycoses are rare and severe diseases affecting immunocompromised hosts, especially diabetic patients during ketoacidosis. The treatment includes surgical debridement and amphotericin B but prognosis remains severe.

Chiasmal infarction and sudden blindness caused by mucormycosis in AIDS and diabetes mellitus.

PURPOSE: To report rapidly progressive rhino-orbitocerebral mucormycosis in a 47-year-old woman with both diabetes mellitus and the acquired immunodeficiency syndrome (AIDS). METHOD: Case report including postmortem examination of the eyes, orbit, and brain of a patient with rhino-orbitocerebral mucormycosis, diabetes mellitus, and AIDS. RESULTS: Invasion by hyphae of the Rhizopus species produced an occlusive vasculitis and massive infarction of the optic chiasm. Fungal organisms were discovered in multiple granulomata of the optic nerve. CONCLUSION: Infarction at the optic chiasm probably caused sudden blindness in this patient.

Unilateral optic neuritis caused by Histoplasma capsulatum in a patient with the acquired immunodeficiency syndrome.

PURPOSE: To evaluate the potential of Histoplasma capsulatum to cause optic neuritis in the setting of the acquired immunodeficiency syndrome (AIDS). METHODS: We examined a 35-year-old man with a history of AIDS and disseminated histoplasmosis who developed a unilateral progressive optic neuritis of enigmatic origin. An optic nerve sheath biopsy was performed to provide a tissue diagnosis. RESULTS: Histoplasma capsulatum was identified in both the optic nerve sheath and fungal culture. CONCLUSION: Histoplasma capsulatum should be considered in the differential diagnosis of optic neuritis in patients with AIDS, even in the absence of chorioretinal findings.

Optic nerve sheath decompression for visual loss in patients with acquired immunodeficiency syndrome and cryptococcal meningitis with papilledema.

Visual dysfunction developing in association with acquired immunodeficiency syndrome (AIDS) can be multifactorial. Two patients with this syndrome and cryptococcal meningitis had papilledema and visual loss. Both were treated by optic nerve sheath fenestration. One patient had bilateral nonsimultaneous optic nerve sheath fenestrations; visual function improved in one eye. The other patient had bilateral visual improvement after a unilateral optic nerve sheath fenestration. Cryptococcal organisms were present in the dural sheath specimens of both patients despite ongoing therapy with antifungal medication. Postoperative orbital infectious complications did not occur. Autopsy examination of one patient showed that the sites of fenestration were patent. Medical treatment of cryptococcal meningitis associated with AIDS has a guarded prognosis. Optic nerve sheath fenestration offers a treatment alternative for papilledema and visual loss that occur with cryptococcal meningitis.

Recovery of viral agents from the central nervous system of cats.

Isolation of viruses from the central nervous system (CNS) of cats was attempted using an explant culture technique and subsequent co-cultivation with Crandell feline kidney (CRFK) or Vero cells. Feline syncytia-forming virus was isolated from the CNS of 11 of 16 cats where the initial co-cultivation was with CRFK cells. Feline panleucopaenia virus was isolated from the CNS of 2 adult cats. Co-cultured cells from the CNS of 3 cats contained eosinophilic cytoplasmic and intranuclear inclusions. The cytoplasmic inclusions consisted of tubular structures, 16-18 nm in diameter and up to 500 nm in length, which were similar in morphology to paramyxovirus nucleocapsids. The 3 co-cultured cells with cytoplasmic and intranuclear inclusions showed haemadsorption of guinea pig erythrocytes. The possible identity of these structures, and their association with a previously described primary focal demyelinating lesion in the CNS of cats, is discussed.