A Case of Endogenous Aspergillus Endophthalmitis Associated with Mycotic Cerebral Aneurysm.

Bae, Sinwoo; Chae, Ju Byung

doi:2011.52.10.1249

J Korean Ophthalmol Soc > Volume 52(10); 2011 > Article

Case Report

Journal of the Korean Ophthalmological Society 2011;52(10):1249-1253.
DOI: https://doi.org/10.3341/jkos.2011.52.10.1249 Published online October 15, 2011.

A Case of Endogenous Aspergillus Endophthalmitis Associated with Mycotic Cerebral Aneurysm.

Sinwoo Bae, Ju Byung Chae

Department of Ophthalmology, College of Medicine, Chungbuk National University, Cheongju, Korea. jbchae@chungbuk.ac.kr

면역저하 환자에서 진균성 대뇌 동맥류를 동반한 안내염 1예

배신우⋅채주병

Department of Ophthalmology, College of Medicine, Chungbuk National University, Cheongju, Korea

Abstract

PURPOSE
To report a case of a endogenous Aspergillus endophthalmitis associated with mycotic cerebral aneurysmal rupture. CASE SUMMARY: A 51-year-old woman was referred to our retina clinic for decreased visual acuity in the left eye. The patient had previously undergone a liver transplant for liver cirrhosis and hepatocellular carcinoma. On fundus examination, vitreous opacities with a yellowish-white subretinal abscess were observed. There were no abnormal findings except the positive sign in the laboratory serum Aspergillus antigen test performed on admission. Based on the suspicion of endogenous endophthalmitis, pars plana vitrectomy was performed with intravitreal antibiotics injection to treat fungal and bacterial infections. There was no growth in either the vitreous or anterior chamber culture. After vitrectomy, visual acuity improved and the inflammation subsided. However, by the three-week follow-up, acute-onset left hemiplegia with a right hemisphere cerebral hemorrhage had occurred. Cerebral magnetic resonance angiography showed multiple mycotic aneurysms characterized by a large and fusiform appearance. The patient was treated with neuro-embolization and was stabilized with minimal sequalae. CONCLUSIONS: Although the immunocompromised endophthalmitis patient can be treated using proper management, brain lesions such as mycotic aneurysm may exist and should be carefully considered.

Key Words: Aneurysm;Aspergillus;Endophthalmitis