Iritis presumed as secondary to disseminated coccidioidomycosis

Hwang, Julie M.; Pian, Debi

doi:10.1016/j.optm.2006.07.010

Cited by 4 publications

(2 citation statements)

References 52 publications

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“… 7 The clinical manifestations include phlyctenular conjunctivitis, episcleritis, scleritis, keratoconjunctivitis, lid granulomata, iridocyclitis, choroiditis, chorioretinitis, endophthalmitis, nerve paralysis, anisocoria, papilledema, optic nerve granuloma, and optic atrophy. 7 , 15 , 20 Ocular involvement is usually associated with disseminated disease 7 , 8 , 15 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ; however, several cases have been reported without clinical evidence of systemic disease. 15 , 24 Orbital coccidioidomycosis should be considered in individuals, especially in endemic regions, presenting with ocular inflammation, particularly if an orbital mass is present.…”

Section: Discussionmentioning

confidence: 99%

Pediatric coccidioidal orbital granuloma

Bittencourt

Okezie

Tawansy³

et al. 2022

American Journal of Ophthalmology Case Reports

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Purpose To report a case of orbital coccidiomycosis in an otherwise healthy 11-month-old male. Observations An 11-month-old male presented to his pediatrician with parental complaints of swelling, erythema, and pain of the right orbit that increased over ten days in the absence of constitutional symptoms. The child's parents reported an earlier fall onto a carpeted floor. After four weeks of conservative treatment and a course of oral cephalexin, he developed a fever, increased erythema, and palpable enlargement of a mass posterior to the lower eyelid. Ultrasound revealed an encysted mass in the inferior orbit, suggestive of an abscess. Urgent ophthalmic referral led to incision and drainage via orbitotomy. Culture, histopathology, and serological testing were positive for Coccidioides spp.. Blood studies revealed mild anemia and thrombocytosis. There was complete resolution of symptoms after surgical drainage and several weeks of oral fluconazole. Conclusion and importance We describe a patient with orbital coccidiomycosis without apparent systemic involvement, following what was most likely an unrelated minor trauma. Despite being rare, orbital coccidiomycosis should be considered as a primary manifestation of infection when ocular inflammation is encountered, especially in endemic regions.

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Section: Discussionmentioning

confidence: 99%

Pediatric coccidioidal orbital granuloma

Bittencourt

Okezie

Tawansy³

et al. 2022

American Journal of Ophthalmology Case Reports

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“…In the anterior segment, C. immitis has been shown to cause conjunctivitis, and iritis. 6 Coccidioidomycosis was historically treated with intravenous amphotericin B, but the triazoles have emerged as the treatment of choice in most cases due to lower toxicity, oral bioavailability, and good efficacy. Recommendations by the Infectious Diseases Society of America for the treatment of coccidioides meningitis suggest fluconazole 400 mg daily (approximately 6 mg/kg/day; the dose most studied in clinical trials) but note that some providers begin therapy with fluconazole dosing between 800 and 1000 mg daily.…”

Section: Discussionmentioning

confidence: 99%

Cystoid Macular Edema Secondary to Fluconazole Toxicity

Magrath¹,

Pulido²,

Montero³

et al. 2010

Ocular Immunology and Inflammation

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Fluconazole is an antifungal commonly used to treat Coccidioides immitis, but this medication has a number of side effects including fatigue, rash, headache, dizziness, nausea, vomiting, diarrhea, and elevated liver enzymes. We are unaware of any cases of retinal toxicity related to fluconazole. In this case we present a 76 year old woman with longstanding Coccidioides treated with high dose fluconazole. She becomes symptomatic with fluconazole toxicity and subsequently develops bilateral cystoid macular edema. As her dose of fluconazole is decreased and she is transitioned to voriconazole the edema resolves and her visual acuity improves. This patient's clinical course illustrates retinal toxicity may present with high and prolonged doses of fluconazole.

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