Kim Esther L, Patel Sachi R, George Meena S, Ameri Hossein
Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USC Roski Eye Institute, Los Angeles, California.
Retin Cases Brief Rep. 2018;12(4):310-313. doi: 10.1097/ICB.0000000000000505.
Ochroconis gallopava is a darkly pigmented septated fungus that rarely infects humans, almost universally immunocompromised individuals. Only one previous case has been reported of O. gallopava endophthalmitis, in which the patient progressed to a visual acuity of no light perception. The authors currently describe the first successfully treated case of O. gallopava endophthalmitis.
A 65-year-old Hispanic woman on chronic immunosuppression after a right lung transplant was admitted to the hospital for O. gallopava respiratory tract infection and was found to have bilateral endogenous endophthalmitis. Examination revealed multiple, cream-colored, chorioretinal lesions in the fundus, including one near the temporal macula in the left eye. There was no diffuse vitritis. Visual acuity was 20/30 in both eyes at presentation but dropped to 20/400 in the right eye and counting fingers at 3 feet in the left eye over the hospital course despite receiving an intravitreal injection of voriconazole in the left eye and concurrent IV amphotericin B, posaconazole, and micafungin. The patient was then treated with multiple simultaneous intravitreal amphotericin B and voriconazole injections bilaterally, as well as IV posaconazole, which was switched to IV voriconazole for improved intraocular penetration.
The chorioretinal lesions were noted to regress with treatment. Concomitantly, the patient's respiratory status improved, and she was discharged with a visual acuity of 20/40 in the right eye and 20/60 in the left eye. The patient completed a 1-year course of oral voriconazole as an outpatient without signs of recurrent activity. Seventeen months after the initial presentation, the patient had 20/40 vision bilaterally with a residual, white, fibrotic scar at the temporal macula in the left eye.
This report describes the first successful treatment regimen against O. gallopava endophthalmitis using a combination of intravitreal amphotericin B and voriconazole injections, as well as IV posaconazole and voriconazole, which resulted in an excellent visual outcome.
加洛帕赭霉是一种色素沉着深的有隔真菌，很少感染人类，几乎均为免疫功能低下者。此前仅报道过1例加洛帕赭霉性眼内炎，该患者视力下降至无光感。作者现描述首例成功治疗的加洛帕赭霉性眼内炎病例。
一名65岁西班牙裔女性，在右肺移植后接受慢性免疫抑制治疗，因加洛帕赭霉呼吸道感染入院，被发现患有双侧内源性眼内炎。检查发现眼底有多个奶油色脉络膜视网膜病变，包括左眼颞侧黄斑附近的一个病变。无弥漫性玻璃体炎。就诊时双眼视力均为20/30，但在住院期间，尽管左眼接受了玻璃体内注射伏立康唑，并同时静脉注射两性霉素B、泊沙康唑和米卡芬净，右眼视力仍降至20/400，左眼视力降至3英尺数指。随后患者双侧同时接受多次玻璃体内注射两性霉素B和伏立康唑治疗，以及静脉注射泊沙康唑，后改为静脉注射伏立康唑以提高眼内渗透性。
脉络膜视网膜病变经治疗后逐渐消退。同时，患者的呼吸状况改善，出院时右眼视力为20/40，左眼视力为20/60。患者作为门诊病人完成了为期1年的口服伏立康唑疗程，无复发活动迹象。首次就诊17个月后，患者双眼视力均为20/40，左眼颞侧黄斑处有残留的白色纤维化瘢痕。
本报告描述了首例成功治疗加洛帕赭霉性眼内炎的方案，采用玻璃体内注射两性霉素B和伏立康唑，以及静脉注射泊沙康唑和伏立康唑联合治疗，取得了极佳的视力预后。
