Histopathological clues in the diagnosis of fungal infection by Scedosporium in a case of endophthalmitis starting as conjunctivitis

Abstract

Cutaneous fungal infections can result in disastrous episodes if improperly diagnosed and treated, especially in immunosuppressed patients. Although dermatopathologists are highly familiar with some filamentous fungi - such as Aspergillus and Zygomycetes - they are not so aware of other less common species. We report a case of ocular infection by Scedosporium apiospermum that started as conjunctivitis and resulted in Phthisis bulbi and subsequent exeresis of the left eye. We describe some of the main morphological features of the fungus as well as the important morphological clues for the differential diagnosis with some similar species, such as Aspergillus, Scopulariopsis, Fusarium, Paecilomyces and Zygomycetes.

Scedosporium apiospermum contact lens-related keratitis: A rare case report and a literature review

“…Broad-spectrum ocular infections with a variable prognosis caused by SA have been reported in the literature [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]; these infections involve the eyelids [19] up to the orbital apex [17]. It can affect both immunocompetent [19, 20, 23-26, 28, 30, 32] and immunocompromised [17,18,21,22,27,29,31,[33][34][35] hosts.…”

“…Broad-spectrum ocular infections with a variable prognosis caused by SA have been reported in the literature [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]; these infections involve the eyelids [19] up to the orbital apex [17]. It can affect both immunocompetent [19, 20, 23-26, 28, 30, 32] and immunocompromised [17,18,21,22,27,29,31,[33][34][35] hosts. Following previous studies on eye infections related to SA, it appears remarkable that most cases require penetrating keratoplasty to restore at least the anatomical structure of the eye [16,20,23,26,28,30].…”

Infección ocular invasora por Scedosporium apioespermum en un paciente inmunocomprometido

“…Se asocia a infecciones invasoras o localizadas con compromiso endocárdico, pulmonar, articular, de piel y tejidos blandos, o en otras localizaciones 1 . Así también, se han reportado casos de conjuntivitis, coriorretinitis, endoftalmitis, queratitis o escleritis, las que pueden evolucionar a una pérdida de visión [2][3][4][5][6][7] . En este contexto, presentamos un caso de infección fúngica invasora (IFI) ocular por S. apiospermium en una paciente con inmunosupresión secundaria a fármacos.…”

“…o pulmonar invasor (sinusitis o neumonía necrosante), infecciones extrapulmonares (ósea, muscular, ocular y del SNC) e infecciones diseminadas 1 . Al respecto, las infecciones oculares engloban casos de queratitis, conjuntivitis, uveítis, coriorretinitis, endoftalmitis e infecciones de la órbita ocular [1][2][3][4][5][6][7] .…”

“…La recaída en infecciones oculares por este microorganismo ha sido comunicada previamente junto a la necesidad de aplicar terapias prolongadas 6 . Un caso semejante de infección necrosante evolucionó rápidamente a un desprendimiento coroideo masivo y, finalmente, de manera precoz, a ptisis bulbi, requiriendo manejo con enucleación 2 .…”