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Diagnosis of Vitreoretinal Aspergillosis with Transvitreal Retinochoroidal Biopsy

Case Reports in Ophthalmological Medicine. 2018;2018 DOI 10.1155/2018/8306163

 

Journal Homepage

Journal Title: Case Reports in Ophthalmological Medicine

ISSN: 2090-6722 (Print); 2090-6730 (Online)

Publisher: Hindawi Limited

LCC Subject Category: Medicine: Ophthalmology

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML, ePUB, XML

 

AUTHORS


Krishi Peddada (Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, PA, USA)

Nida M. Khan (Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, PA, USA)

Jascha Rubin (Rittenhouse Hematology/Oncology, Philadelphia, PA, USA)

Haykanush Zakaryan (Department of Radiology, Drexel University College of Medicine, Philadelphia, PA, USA)

Yaobin Liu (Department of Pathology & Laboratory Medicine, Drexel University College of Medicine, Philadelphia, PA, USA)

Nikolay Popnikolov (Department of Pathology & Laboratory Medicine, Drexel University College of Medicine, Philadelphia, PA, USA)

Roshun Sangani (Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, PA, USA)

Weiye Li (Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, PA, USA)

EDITORIAL INFORMATION

Blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 14 weeks

 

Abstract | Full Text

Diagnosing culture-proven endophthalmitis is complicated by the insufficient yield of intraocular samples and the variety of etiologies which mimic true endophthalmitis. In cases of impending vision loss where vitreous biopsy cannot provide a definitive diagnosis, transvitreal retinochoroidal biopsy can be an effective next step. Our case is a 48-year-old male with B-cell acute lymphoblastic leukemia that presented with counting fingers vision, redness, and tearing of the left eye. Exam showed cell and flare with hypopyon as well as dense vitritis. The patient underwent diagnostic pars plana vitrectomy and vitreous culture was negative at the time. Flow cytometry demonstrated no malignant cells. However, the patient’s vision and mental status continued to clinically decline despite being started on intravitreal and systemic antibiotic and antifungal therapy. Neuroimaging revealed rim-enhancing brain lesions. Transvitreal retinochoroidal biopsy was performed in an elevated area of the retina. The biopsy helped rule out malignancy and showed acute-angle, septate, branching hyphae characteristic of Aspergillus fumigatus. Ultimately, the vitreous biopsy, cultures, and a biopsy from the left frontal lobe brain abscess all confirmed this diagnosis as well. Transvitreal retinochoroidal biopsy can play a role in the diagnosis of a case of posterior uveitis and can be particularly effective in diagnosing a fungal endophthalmitis.