Pulido J S, Folberg R, Carter K D, Coonan P
Department of Ophthalmology, University of Iowa Hospitals & Clinics, Iowa City 52242.
Ophthalmology. 1990 Feb;97(2):217-20. doi: 10.1016/s0161-6420(90)32603-9.
A 60-year-old white man from an area endemic for Histoplasma capsulatum presented with a vitreous wick, hypopyon iritis, and dense vitreitis 2 months after removal of an anterior chamber intraocular lens (IOL) for chronic iritis. A diagnostic vitrectomy was performed and H. capsulatum was cultured and identified 2 weeks later. Despite intravitreal and intravenous amphotericin as well as repeat vitrectomies, the inflammation worsened and the eye was removed. Results of histopathologic examination showed Histoplasma organisms along the vitreous wick, over the surface of the iris and ciliary body, and over the retina. No organisms were found in the choroid. Dalen-Fuchs-type nodules similar to those of sarcoid also were noted, but there was no evidence of granulomatous inflammation in the uvea. Because of his unilateral disease with Histoplasma in the vitreous wick, negative serology, and an absence of systemic infection, the authors believe that this patient had a previously unreported form of ocular Histoplasma, exogenous postoperative Histoplasma endophthalmitis.
一名来自荚膜组织胞浆菌病流行地区的60岁白人男性，因慢性虹膜炎在前房人工晶状体（IOL）摘除术后2个月出现玻璃体条索、前房积脓性虹膜炎和浓密的玻璃体炎。进行了诊断性玻璃体切除术，2周后培养并鉴定出荚膜组织胞浆菌。尽管给予了玻璃体内和静脉注射两性霉素以及重复玻璃体切除术，但炎症仍加重，最终摘除了眼球。组织病理学检查结果显示，在玻璃体条索、虹膜和睫状体表面以及视网膜上均发现了荚膜组织胞浆菌。脉络膜中未发现病原体。还发现了类似于结节病的Dalen-Fuchs型结节，但葡萄膜中没有肉芽肿性炎症的证据。由于该患者为单侧疾病，玻璃体条索中有荚膜组织胞浆菌，血清学检查为阴性，且无全身感染，作者认为该患者患有此前未报道过的眼部荚膜组织胞浆菌病形式，即外源性术后荚膜组织胞浆菌性眼内炎。
