COCCIDIOIDOMYCOSIS WITH NECROTIZING GRANULOMATOUS CONJUNCTIVITIS

A patient with a steroid-resistant conjunctival nodule developed sever e necrotizing granulomatous conjunctivitis during aggressive treatment with topical, subconjunctival, and systemic steroids. Culture of the tissue yielded Coccidioides immitis. A cavitary lesion was noted on a chest radiograph, and the same organism was recovered from a lung biop sy specimen. The granulomatous conjunctivitis was controlled only afte r aggressive debridement of the affected area and months of treatment with topical amphotericin B and oral fluconazole. A review of the lite rature suggests that subclinical ocular involvement from pulmonary coc cidioidomycosis may be more common than generally believed. Conditions that blunt the host immune response may lead to a higher incidence of clinically significant ocular involvement.