Untersuchungen zum sogenannten „okulären Histoplasmose-Syndrom”*

Abstract

The authors describe seven patients presenting with ophthalmoscopic findings typical of "presumed ocular histoplasmosis syndrome." However, no humoral antibodies could be demonstrated. Moreover, the results of skin tests were all negative even after "boostering." Hence, the diagnosis of ocular histoplasmosis had to be ruled out. Tests for listeriosis, lues, leptospirosis, ornithosis, Toxocara canis, toxoplasmosis, Larva migrans, and Candida albicans were also negative. There are evidently other, so far unknown, agents which lead to an ophthalmoscopic picture that mimics ocular histoplasmosis with its typical "punched-out lesions" and central hemorrhagic chorioretinopathy. One of these agents may be Epstein-Barr virus, because two of six patients had increased antibody levels of Epstein-Barr nuclear antigen and early antigen, indicating an active or persistent state of viral infection.

Retinal vasculitis with multifocal retinochoroiditis

“…However, their patients were younger with an average age of 33 years compared to 61 years in our study. With respect to differential diagnosis, other severe intraocular inflammatory diseases need to be considered, but can be excluded in all probability: in ocular histoplasmosis syndrome the anterior segment and the vitreous are free of inflammatory changes and there are fewer retinal scars than in our cases [1]. Birdshot-choroidopathy also presents with vitreous haze and retinal scarring, but lesions are more 'cream coloured' and not pigmented [6].…”

Vasculitis retinae mit multifokaler Retinochorioiditis

“…Gass,1968: Nozik & Dorsch, 1973: Gass & Mitarb., 1978 Ryan & Maumenea, 1 980: Differentialdiagnostisch sind zwar weitere intraokulare Entzundungserkrankungen in Betracht zu ziehen, lassen sich aber doch mit groller Wahrscheinlichkeit ausschliellen. Beim ,,Okulären Histoplasmosesyndrom" sind vordere Augenabschnitte und Glaskorper frei von entzundlichen Veranderungen, die Netzhautherde sind in aller Regel nicht so zahlreich und so dicht wie in unseren Fallen (Gass 1972, Lund 1982, Mant hey und Schenck 1985, Behrens-Baumann 1988. Parapapillare Narben und subretinale Neovaskularisationsmembranen sind haufig, ja nahezu regelmaflig zu erwarten.…”