Aspergillus fumigatus Scleritis Associated with Monoclonal Gammopathy of Undetermined Significance

Abstract

A 68-year-old woman presented with pain in her left eye. Necrosis with calcium plaques was observed on the medial part of the sclera. Aspergillus fumigatus was isolated from the culture of the necrotic area. On systemic work-up including serum and urine electrophoresis studies, the serum monoclonal protein of immunoglobulin G was detected. The patient was diagnosed with monoclonal gammopathy of undetermined significance and fungal scleritis. Despite intensive treatment with topical and oral antifungal agents, scleral inflammation and ulceration progressed, and scleral perforation and endophthalmitis developed. Debridement, antifungal irrigation, and tectonic scleral grafting were performed. The patient underwent a combined pars plana vitrectomy with an intravitreal injection of an antifungal agent. However, scleral and intraocular inflammation progressed, and the eye was enucleated. Aspergillus fumigatus was isolated from the cultures of the eviscerated materials. Giemsa staining of the excised sclera showed numerous fungal hyphae.

Late-Onset Necrotizing Scleritis Due to Pigmented Mycetoma (Dematiaceous Fungi) in 2 Cases

“…We identified 29 cases of fungal scleritis or keratoscleritis cases reported in 14 studies. [10][11][12][13][14][15][16][17][18][19][20][21][22][23] The latent period for the occurrence of infectious scleritis after pterygium surgery ranged from weeks to 12 years. Adjuvant therapy at the time of pterygium surgery was used in 55% (38% b-irradiation, 17% mitomycin C) of eyes.…”