UNILATERAL BLASTOMYCES-DERMATITIDIS ENDOPHTHALMITIS AND ORBITAL CELLULITIS - A CASE-REPORT AND LITERATURE-REVIEW

Purpose: The authors report the clinical, cytologic, and histopatholog ic findings of a unique presentation of concomitant unilateral endopht halmitis and orbital cellulitis secondary to Blastomyces dermatitidis. Design: Case report. Methods: A 29-year-old healthy woman with a hist ory of pulmonary tuberculosis presented with a painful right eye and r apidly decreasing vision. Fundus examination showed a diffuse elevated choroidal lesion at the posterior pole. With an otherwise unremarkabl e systemic work-up, the patient was treated with systemic antibiotics and corticosteroids for a presumed diagnosis of choroidal tuberculous granuloma, After an initial response to the treatment, the patient's c ondition deteriorated rapidly with visual acuity decreasing from 20/25 to no light perception in 3 months. Ipsilateral proptosis developed w ith magnetic resonance imaging showing a poorly defined orbital mass. Surgical enucleation and an orbital biopsy were performed. Results: Hi stopathologic examination of the orbital specimen and an intact enucle ated globe showed a diffuse necrotizing granulomatous process with the presence of numerous yeasts consistent with B. dermatitidis. This sub sequently was confirmed by positive culture of B. dermatitidis from th e orbital specimen. Conclusions: This is a unique case of concurrent u nilateral endophthalmitis and orbital cellulitis secondary to B. derma titidis. Intraocular dissemination of blastomycosis should be suspecte d in the differential diagnosis of endophthalmitis in patients with pr evious or active pulmonary lesions of equivocal nature, Early diagnosi s and prompt treatment with antifungal medications are essential.