Schils Raphaël, Rampat Radhika, Rakic Jean-Marie, Crahay François-Xavier
Department of Internal Medicine and Infectious Diseases, University of Liege, Liege, Belgium.
Department of Ophtalmology, Queen Victoria Hospital NHS Foundation, East Grinstead, United Kingdom.
IDCases. 2023 May 8;32:e01793. doi: 10.1016/j.idcr.2023.e01793. eCollection 2023.
Infection by spp is a potentially life-threatening condition among both immunocompromised and immunocompetent patients. chorioretinitis can occur as a complication of candidemia and may develop into endophthalmitis if not detected and treated early, which can lead to irreversible visual loss. Here, we report on a 52-year-old diabetic woman who developed candidemia complicated by bilateral chorioretinitis following kidney transplantation. Antifungal therapy was immediately started but fundoscopic examination highlighted multiple bilateral chorioretinal lesions. Given new onset of vomiting and increased number of retinal lesions on repeat fundus examination a few weeks later, the patient underwent a positron emission tomography (PET) which revealed a mycotic arterial pseudoaneurysm at the renal graft anastomosis. It led ineluctably to transplantectomy, aneurysm flattening and vascular reconstruction a few days later. Blood cultures remained negative and fundus examination progressively showed a regression of chorioretinal lesions until their complete disappearance a few months later. Our case emphasizes the importance of a non-invasive examination which allowed to accelerate and optimize in a consequential way the management of the patient leading to her recovery after a long antifungal treatment.
spp感染在免疫功能低下和免疫功能正常的患者中都是一种潜在的危及生命的状况。脉络膜视网膜炎可作为念珠菌血症的并发症出现,如果不及早发现和治疗,可能发展为眼内炎,这会导致不可逆转的视力丧失。在此,我们报告一名52岁的糖尿病女性,她在肾移植后发生念珠菌血症并并发双侧脉络膜视网膜炎。立即开始抗真菌治疗,但眼底检查发现多个双侧脉络膜视网膜病变。几周后,鉴于再次眼底检查时出现新的呕吐症状且视网膜病变数量增加,该患者接受了正电子发射断层扫描(PET),结果显示肾移植吻合处有一个真菌性动脉假性动脉瘤。这不可避免地导致几天后进行移植肾切除术、动脉瘤修复和血管重建。血培养结果一直为阴性,眼底检查逐渐显示脉络膜视网膜病变消退,直到几个月后完全消失。我们的病例强调了非侵入性检查的重要性,它能够以一种重要的方式加速并优化患者的治疗管理,使其在经过长时间的抗真菌治疗后康复。