Aspergillus spp. panophthalmitis with intralenticular invasion in dogs: report of two cases.

This case series describes the ocular, clinical and histologic manifestations of disseminated Aspergillosis in two dogs. Two dogs presented for severe unilateral panophthalmitis and secondary glaucoma with positive Aspergillus spp. titers. Case 1 showed no clinicopathologic systemic symptoms of fungal dissemination, however, case 2 was affected with acute renal failure. The affected eye of case 1 did not respond to medical therapy and was enucleated for comfort. The affected eye of case 2 responded to aggressive topical and systemic medical therapies, however, the patient was euthanized for acute renal failure. Globes were collected for histologic evaluation at the time of death. Histology of both revealed panophthalmitis with presence of significant intraocular hemorrhage, multifocal fungal granulomas, retinal and optic nerve changes consistent with secondary glaucoma, rupture of the anterior lens capsule, and fungal invasion and colonization of the intralenticular space. These cases represent a unique and devastating ocular manifestation of disseminated Aspergillosis. Cases presenting with uveitis and secondary glaucoma of unknown origin, especially with confirmed or suspected lens capsular rupture, should have serologic testing for this infectious agent.

Platelet Transfusion Related Panophthalmitis and Endophthalmitis in Patients with Dengue Hemorrhagic Fever.

Dengue is a vector-borne viral illness of major public health importance. It is endemic in many parts of India and also causes frequent epidemics. Platelet transfusions are given in severe cases of dengue fever to treat and prevent hemorrhagic complications. Here, we report three patients in North India with development of panophthalmitis and endophthalmitis shortly after receiving platelet transfusion.

Panoftalmitis: presentación atípica de un melanoma coroideo / Panophthalmitis: atypical presentation of choroid melanoma

RESUMEN La panoftalmitis es una forma rara y grave ocular de presentación del melanoma coroideo, por lo que, ante la presencia de una masa intraocular e inflamación de todas las estructuras intraoculares, con extensión extraescleral y los tejidos vecinos de la órbita, debe considerarse el diagnóstico diferencial de esta neoplasia maligna. Se presenta el caso de un paciente masculino de 83 años de edad, con diagnóstico de panoftalmitis como presentación atípica de un melanoma coroideo. Acudió a consulta de Cuerpo de Guardia de Oftalmología con dolor ocular intenso en ojo derecho, acompañado de náuseas y vómitos. Se constató, al examen, hipertensión ocular, que evolucionó tórpidamente durante su ingreso, con inflamación intraocular con extensión extraescleral. Se le realizaron ultrasonido ocular y tomografía axial computarizada de órbitas y se diagnosticó una panoftalmitis secundaria a un melanoma coroideo. Los hallazgos clínicos de esta forma atípica de presentación se mostraron, cuyo tratamiento definitivo es la enucleación. El diagnóstico histológico de melanoma maligno coroideo necrótico fue confirmado.

ABSTRACT Panophthalmitis is a rare and severe ocular form of presentation of choroid melanoma, therefore, in the presence of intraocular mass and inflammation of all intraocular structures, with extra-scleral extension and to the tissues neighboring the orbit, the differential diagnosis of this malignant neoplasia should be considered. The case presented deals with a male patient, aged 83 years, with diagnosis of panophthalmitis as atypical presentation of choroid melanoma. He assisted to the consultation of Ophthalmology Emergency with intense ocular pain in the right eye, accompanied by nausea and vomits. On examination, ocular hypertension was observed, that torpidly evolved during admission, with intraocular inflammation with extra-scleral extension. He had ocular ultrasound and computed axial tomography of orbits and was diagnosed with panophthalmitis secondary to choroid melanoma. The clinical findings of this atypical presentation form showed, whose definite treatment is enucleation. Histological diagnosis of necrotic choroid malignant melanoma was confirmed.

Orbital Cellulitis with Endogenous Panophthalmitis Caused by Methicillin-Sensitive Staphylococcus aureus in Pregnancy.

Orbital cellulitis along with panophthalmitis is uncommon. The causes are usually trauma-related or endogenous. The prognosis in terms of globe salvage is very poor, with most cases usually requiring enucleation or evisceration of the affected eye. Immunosuppression in some form is usually present, which accounts for the aggressive course of the infection. In this communication, we report on a case in a 25-year-old female, who in the second trimester of pregnancy had developed orbital cellulitis and panophthalmitis caused by methicillin-sensitive Staphylococcus aureus (MSSA), with the primary source of infection being cellulitis on her forearm following intravenous therapy for severe anemia. Despite intensive intravenous and topical antibiotics, she required an evisceration of the eye. However, the pregnancy continued uneventfully with the delivery of a full-term, healthy infant. Bacteremia, although rare in pregnancy, can cause endogenous panophthalmitis and orbital cellulitis, especially in a background of immunosuppresssion.

Clostridium septicum panophthalmitis with systemic complications.

A fulminant case of endophthalmitis due to Clostridium septicum is described. The patient presented with spontaneous gas gangrene panophthalmitis, with early visual loss and an air bubble in the anterior chamber. Death ensued, and necropsy revealed changes consistent with severe arterosclerotic cardiovascular disease, a relationship not uncommon in patients with clostridium sepsis. This association as well as the histopathology of the globe are discussed.

Sudden visual loss associated with clostridial bacteraemia.

A patient with endogenously acquired Clostridium septicum panophthalmitis is presented. The patient exhibited a striking sequence of signs and symptoms associated with this devastating ocular infection. Intensive antibiotic therapy was ineffective and enucleation of the globe was required. The microscopic pathology of the enucleated globe showed extensive infarction and necrosis of ocular structures in association with the panophthalmitis. In addition thrombosis of the central retinal artery and of choroidal vessels was observed.

Aspergillus panophthalmitis complicating treatment of pterygium.

A 58-year-old woman lost her left eye due to Aspergillus panophthalmitis four months after excision of a pterygium. The patient had received postoperative beta radiation and developed a scleral ulcer in the area of treatment from which no organisms could be cultured on two occasions. Because of the difficulty of diagnosing superficial mycotic infections of the eye, and because the treatment of so-called radiation scleritis may worsen fungal infections, ophthalmologists need to be aware of the potential infectious complications associated with the treatment of pterygia.

Lactococcus garvieae and Streptococcus iniae infections in rainbow trout Oncorhynchus mykiss: similar, but different diseases.

Clinical and macroscopic findings (anorexia, lethargy, loss of orientation and exophthalmia) indicate that Streptococcus iniae and Lactococcus garvieae infections of trout share some common features, but histopathology reveals notable differences between the 2 diseases. Meningitis and panophthalmitis are the main lesions among S. iniae infected trout, whereas L. garvieae infection results in a hyperacute systemic disease. Differences in the LD50s of the 2 pathogens and the sudden onset of signs and death correlate with the histopathological findings, indicating the severity of L. garvieae infection of trout.

Lasiodiplodia theobromae panophthalmitis.

Lasiodiplodia theobromae is a rare ocular pathogen. We report a case of panophthalmitis caused by this fungus. The patient was a healthy 62-year-old janitor with no history of ocular trauma in whom keratitis developed. Cultures of corneal scrapings identified the fungus. Despite treatment with appropriate antimycotics the keratitis progressed to infectious scleritis and then spontaneous perforation of the globe, which necessitated enucleation. The ultrasonographic, microbiologic and histologic findings are discussed and the results of in-vitro sensitivity testing presented.

Mycotic keratitis in a reticulated python.

An adult male python was observed to have an inflamed right eye. After several weeks of antibiotic and corticosteroid therapy, a granulomatous mass was noticed on the cornea. The condition became progressively worse and the eye was enucleated. The histologic diagnosis was granulomatous mycotic keratitis with panophthalmitis.

Uveal tuberculosis.

Ocular tuberculosis should be considered in the differential diagnosis of panophthalmitis, uveitis, and intraocular neoplasms. We have presented 6 cases illustrating some of the clinical and pathological characteristics of two types of ocular involvement, acute tuberculous panophthalmitis and ciliary body tuberculoma. The former should be entertained when panophthalmitis or uveitis occur in debilitated patients with obvious systemic tuberculosis foci. Ciliary body tuberculoma should be suspected in relatively healthy individuals with a history of tuberculosis and an intraocular mass. The diagnosis is confirmed by positive cultures or the identification of the organism by acid-fast stains. Typical histopathology in the appropriate clinical setting is sufficient to start specific antituberculous therapy, which should be used in all cases.

Panophthalmitis and otitis interna in fire-bellied toads.

Microbiologic and histologic studies were made of fire-bellied toads with signs of ocular and central nervous system disease. Providencia alcalifaciens, Citrobacter freundii, Aeromonas hydrophila, and other gram-negative bacilli were isolated from the eyes and multiple tissues of ill toads. The histologic evaluations revealed severe panophthalmitis and otitis interna.

Panophthalmitis due to rhizopus in an AIDS patient: a clinicopathological study.

Various opportunistic infections in the eye have been reported earlier in AIDS. We report a case of panophthalmitis in an AIDS patient where the eviscerated tissue on histopathologic and microbiologic examination showed the fungus Rhizopus.

Unilateral proptosis and orbital cellulitis in eight African hedgehogs (Atelerix albiventris).

Eight African hedgehogs (Atelerix albiventris) were presented with unilateral proptosis. Six animals presented specifically for an ocular problem, whereas two had concurrent neurologic disease. Enucleation and light microscopic examination of tissues was performed in five animals, and euthanasia followed by complete postmortem examination was performed in three animals. Histopathologic findings in all hedgehogs included orbital cellulitis, panophthalmitis, and corneal ulceration, with perforation in seven of eight eyes. The etiology of the orbital cellulitis was not determined, but it appeared to precede proptosis. Orbits in hedgehogs are shallow and the palpebral fissures are large, which may predispose them to proptosis, similar to brachycephalic dogs. This clinical presentation was seen in 15% (8/54) of African hedgehogs presented to the Western College of Veterinary Medicine over a 2-yr period from January 1995 to December 1996 and warrants further investigation.