Cleveland Clinic Cole Eye Institute, Cleveland, Ohio.
Cleveland Clinic Department of Infectious Disease, Cleveland, Ohio.
Retin Cases Brief Rep. 2024 Mar 1;18(2):145-148. doi: 10.1097/ICB.0000000000001326.
BACKGROUND/PURPOSE: To report a unique case of pacemaker-related infective endocarditis manifesting as endogenous endophthalmitis with chorioretinitis secondary to Histoplasma capsulatum.
Case report.
A 75-year-old man was diagnosed with blood culture-negative infective endocarditis and was admitted with deteriorating vision and ocular inflammation. Examination of the eye indicated significant vitreous inflammation and retinitis. Vitreous cultures were negative, but universal fungal polymerase chain reaction of the vitreous fluid was positive for H. capsulatum. Histopathology of the fibrous cuff around the extracted right atrial lead demonstrated hyphal and yeast forms and polymerase chain reaction of this material identified H. capsulatum. Despite aggressive antifungal and surgical treatment, the eye became phthisical.
We highlight the importance of considering H. capsulatum in the differential diagnosis of endogenous endophthalmitis, particularly among patients from endemic areas who present with possible endovascular infection.
背景/目的：报告一例独特的起搏器相关感染性心内膜炎病例，表现为眼内炎伴脉络膜视网膜炎，继发于荚膜组织胞浆菌。
病例报告。
一名 75 岁男性被诊断为血培养阴性感染性心内膜炎，并因视力恶化和眼部炎症入院。眼部检查显示明显的玻璃体炎症和视网膜炎。玻璃体培养阴性，但玻璃体的通用真菌聚合酶链反应阳性，提示为荚膜组织胞浆菌。从提取的右心房导线周围纤维袖带的组织病理学检查显示有菌丝和酵母形态，该材料的聚合酶链反应鉴定为荚膜组织胞浆菌。尽管进行了积极的抗真菌和手术治疗，但眼睛还是失明了。
我们强调了在鉴别诊断内源性眼内炎时应考虑荚膜组织胞浆菌的重要性，特别是对于来自流行地区且可能存在血管内感染的患者。
