Diagnostic and Therapeutic Challenges in Ocular Histoplasmosis – A Case Report

ABSTRACT

Purpose: To report a rare case of skin biopsy proven Histoplasma panuveitis.

Method: Observational case report of a 76-year-old Asian Indian man presented as panuveitis. Clinical course, diagnostic and treatment difficulties and confocal microscopy findings were studied.

Result: Patient presented with mild anterior uveitis, membranous vitritis and large chorio-retinal lesions in peripheral fundus with a small macular scar in the right eye. Positive quantiferon test along with chest and adrenal findings initially misled ophthalmologist and pulmonologist to commence anti-tubercular treatment with steroids which further worsened the inflammation and the fungus involved iris and scleral tissue. Skin biopsy from the lesions on thigh revealed histoplasma spores and confocal microscopy showed similar cystic lesions on endothelium. Prolonged course of anti-fungal with steroids resulted in resolution of the infection.

Conclusion: Histoplasma uveitis can worsen with steroids only treatment and may invade iris and scleral tissue which may require prolonged treatment with antifungal agents.

KEYWORDS:

• Histoplasmosis
• Histoplasma Spores
• Confocal microscopy
• Panuveitis
• POHS

Acknowledgment

We acknowledge Dr Vinay Devraj, infectious specialist, Apollo Hospital, Bangalore, India, for proving treatment details of the patient and Dr Shruthi Srinivas and Dr Akhila Sridharan, Narayana Nethralaya, Bangalore, India, for providing the slit-lamp and fundus images.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.