Endogenous endophthalmitis caused by Histoplasma capsulatum var. capsulatum - Case report and literature review

Objective: We report the first case of clinically diagnosed endogenous endo phthalmitis caused by Histoplasma capsulatum var. capsulatum in a patient w ith the acquired immune deficiency syndrome. Design: interventional case report and literature review, Intervention: Pars plana vitrectomy and scleral buckling procedure in the l eft eye with intravenous and intravitreal amphotericin in both eyes. Main Outcome Measures: The clinical features, culture results, visual outco me, and complications were studied. Results: This case demonstrates a bilateral endophthalmitis with severe sub retinal exudation, choroidal granulomas, and intraretinal hemorrhage leadin g to exudative bilateral retinal detachments. Vitreous cultures grew H, cap sulatum var. capsulatum, Treatment consisted of intravenous amphotericin, i ntravitreal amphotericin (both eyes), pars plana vitrectomy (left eye), and scleral buckling procedure (left eye) with resulting counting fingers visi on (right eye) and 20/300 (left eye). Four cases of Histoplasma endophthalm itis have been reported previously, all of which had a documented history o f disseminated histoplasmosis and resulted in enucleation. Conclusions: H. capsulatum should be considered a possible etiologic agent of endophthalmitis, especially in patients with a history of disseminated h istoplasmosis and/or immune deficiency. (C) 2000 by the American Academy of Ophthalmology.