Ke. Hunt et Bj. Glasgow, ASPERGILLUS ENDOPHTHALMITIS - AN UNRECOGNIZED ENDEMIC DISEASE IN ORTHOTOPIC LIVER-TRANSPLANTATION, Ophthalmology, 103(5), 1996, pp. 757-767
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.