ASPERGILLUS ENDOPHTHALMITIS - AN UNRECOGNIZED ENDEMIC DISEASE IN ORTHOTOPIC LIVER-TRANSPLANTATION

Purpose: The authors discovered an unusually high incidence of Aspergi llus endophthalmitis in an autopsy series of orthotopic liver transpla ntation recipients. This study was conducted to discern the frequency, topographic distribution, and potential significance of the infection s. Methods: Autopsy reports from liver transplant patients were review ed. All patients with Aspergillus endophthalmitis were studied by gros s and histologic examination. Histologic sections were stained with Gr ocott-Gomori methenamine-silver nitrate and periodic acid-Schiff stain s. Some Grocott-Gomori methenamine-silver nitrate stained sections wer e counterstained with hematoxylin-eosin. The distribution of ocular in fections in the eye was determined for each patient. The organs infect ed were determined at autopsy. Results: The authors found seven patien ts with Aspergillus endophthalmitis. Six of these seven patients were from a group of 85 (7.1%) orthotopic liver transplantation recipients. Fourteen (16.5%) orthotopic liver transplantation recipients had inva sive pulmonary aspergillosis and ten (11.8%) had disseminated disease, The eyes were the second most common site of infection. Two patients had ocular involvement as the only nonpulmonary site of infection. Asp ergillus endophthalmitis was diagnosed in only one patient before deat h. Infection was located posterior to the equator in all patients; thr ee patients were anterior to the equator as well. The retina (5/7), vi treous (5/7), and choroid (3/7) were common sites of infection. Conclu sions: This is the first report of Aspergillus endophthalmitis associa ted with orthotopic liver transplantation recipients. Patients with or thotopic liver transplants are unusually susceptible to invasive asper gillosis and Aspergillus endophthalmitis. Aspergillus infection is fre quently bilateral, begins posteriorly in the retina or choroid, and ha s vitreous involvement. Recognition of this entity is important becaus e many patients die of disseminated Aspergillus infection that may be detected early with bedside funduscopic examination.