Infección de cavidad anoftálmica por Scedosporium sp. en paciente inmunocompetente: Reporte de caso / Anophthalmic socket infection caused by Scedosporium sp. in immunocompetent patient: Case Report

Resumen Scedosporium sp. es un género de hongos filamentosos que de forma infrecuente se relaciona a infecciones localizadas o diseminadas en pacientes inmunocom prometidos, o inmunocompetentes con trauma penetrante contaminado. Reportamos el caso de un paciente masculino de 31 años con antecedente de trauma penetrante por arma de fuego requiriendo enucleación de su ojo izquierdo, quien 12 años posterior al trauma inicial presenta necrosis de la cavidad anoftálmica con extrusión del implante y lisis del párpado inferior, finalmente identificando Scedosporium sp. como germen causal, y un mucocele en el seno frontal como reservorio. El paciente recibió tratamiento médico con voriconazol sistémico, desbridamiento quirúrgico amplio, y resección endoscópica del quiste de retención mucoso, con una evolución satisfactoria. Las infecciones micóticas de la cavidad anoftálmica son infrecuentes, requiriendo una alta sospecha diagnóstica y trata miento agresivo para evitar consecuencias potencialmente devastadoras.

Abstract Scedosporium sp. is a genus of filamentous fungi that is infrequently related to localized or disseminated infections in either immunocompromised patients, or immunocompetent patients with penetrating contaminated trauma. We report the case of a 31-year-old patient with a history of penetrating gunshot wound that required enucleation of his left eye, who 12 years after initial trauma presents necrosis of the anophthalmic socket with implant extrusion and lysis of inferior eyelid, finally identifying the causal agent to be Scedosporium sp. The patient received medical treatment with systemic voriconazole, and wide surgical debridement, with a satisfactory evolution. Fungal infections of anophthalmic sockets are infrequent, requiring a high diagnostic suspicion and aggressive treatment to avoid potentially devastating consequences.

[Conjunctival mass as the first manifestation of Epstein Barr virus infection]. / Masa conjuntival como primera manifestación de infección por virus del Epstein Barr.

The Epstein Barr virus is an infectious disease with a high worldwide prevalence, which can present multiple systemic manifestations. The ophthalmological findings are the least frequent and nonspe cific and, therefore, its diagnosis is complicated and delayed; however, it should always be considered as a diagnostic possibility in the presence of atypical ocular and periocular inflammatory clinical pictures. OBJECTIVE: To describe the clinical case of a patient with the presence of a conjunctival mass as the first finding in Epstein Barr virus infection. CLINICAL CASE: A 4-year-old boy with a 4-day history of left upper eyelid edema and ptosis associated with a large, fast-growing, elevated, painful, and salmon-colored upper bulbar conjunctival mass with extension to the upper fornix associated with bilateral cervical and inguinal lymphadenopathy. Initially, a lymphoproliferative disorder was suspected, with blood count with lymphocytosis and atypical lymphocytes, elevated lactate dehydro genase, peripheral blood smear with an increase in white blood cells and some atypical lymphocytes, bone marrow aspirate with a predominance of granulocytes and predominantly CD8-positive T lym phocytes and an increase in Gamma-Delta T lymphocytes. The orbit CT scan showed thickening of the left upper eyelid with peripheral enhancement and the abdominal CT scan showed splenomegaly. Biopsy confirmed chronic Epstein Barr virus infection with positive IgM and indeterminate IgG anti bodies. Symptomatic management was indicated with satisfactory evolution and complete resolution of the conjunctival lesion and lymphadenopathy. CONCLUSION: Epstein Barr virus infection should be considered as a possible diagnosis in atypical ocular and periocular inflammatory manifestations in the pediatric population.

Tumor de tritón benigno: reporte de un caso en órbita / Orbit Benign triton Tumor: Case Report

El artículo presenta el caso de una mujer de 49 años de edad sin antecedentes patológicos con proptosis axial progresiva izquierda de un año de evolución asociada a dolor ocular, sin cambios en la agudeza visual, sin limitación en los movimientos oculares ni diplopía. Con imágenes sugestivas de seudotumor versus schwannoma versus hemangioma cavernoso orbitario versus dermoide intraconal. Fue llevada a resección de masa vía orbitotomía anterior transconjuntival. Esta fue una lesión compatible histológicamente con hamartoma neuromuscular (tumor de tritón benigno).

This article shows the case of a 49-year-old woman with no medical history, developed a progressive left axial proptosis associated with ocular pain. There are no changes to visual acuity, limitation of eye movement or diplopia. The diagnostic images may suggest one of the following: pseudotumor, schwannoma, orbital cavernous hemangioma or intraconal dermoid. The resected specimen was taken via anterior transconjuntival orbitotomy. Microscopic examination of the tumor showed a neuromuscular hamartoma (benign triton tumor).