Patel A S, Hemady R K, Rodrigues M, Rajagopalan S, Elman M J
Department of Ophthalmology, University of Maryland Hospital, Baltimore 21201.
Am J Ophthalmol. 1994 Mar 15;117(3):363-8. doi: 10.1016/s0002-9394(14)73147-2.
Endogenous fungal endophalmitis is an uncommon complication of systemic mycosis. Only a few cases involving Fusarium have been reported, most with unfavorable visual outcomes. We examined a 31-year-old woman with acute lymphocytic leukemia who developed sudden visual loss in her right eye. A dense, white placoid infiltrate was present in the right macula extending into the vitreous. An iris nodule and hypopyon were present in the left eye. A vitreous aspirate of the right eye was positive for Fusarium species. The patient progressively lost vision despite amphotericin B and 5-fluorocytosine therapy. She died from bronchopneumonia, fungemia, and multisystem failure. Histopathologic study disclosed a panophthalmitis with Fusarium organisms invading all the ocular coats in the right eye. Leukemic infiltrates were present in the left iris, anterior chamber, and trabecular meshwork. The ocular destructiveness of Fusarium may be caused by marked mycotic vascular invasion and occlusion with consequent infarction and necrosis of ocular tissues.
内源性真菌性眼内炎是系统性真菌病的一种罕见并发症。仅报道了少数几例涉及镰刀菌的病例，大多数病例视力预后不佳。我们检查了一名31岁的急性淋巴细胞白血病女性，她右眼突然失明。右眼黄斑区有致密的白色扁平状浸润，延伸至玻璃体。左眼有虹膜结节和前房积脓。右眼玻璃体抽吸物镰刀菌属检测呈阳性。尽管接受了两性霉素B和5-氟胞嘧啶治疗，患者视力仍逐渐丧失。她死于支气管肺炎、真菌血症和多系统衰竭。组织病理学研究显示右眼全眼球炎，镰刀菌侵入所有眼组织层。白血病浸润存在于左眼虹膜、前房和小梁网。镰刀菌对眼的破坏作用可能是由于显著的真菌性血管侵袭和阻塞，继而导致眼组织梗死和坏死。
