Diagnosis of Vitreoretinal Aspergillosis with Transvitreal Retinochoroidal Biopsy
Diagnosing culture-proven endophthalmitis is complicated by the insufficient yield of intraocular samples and the variety of etiologies which mimic true endophthalmitis. In cases of impending vision loss where vitreous biopsy cannot provide a definitive diagnosis, transvitreal retinochoroidal biopsy...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Case Reports in Ophthalmological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2018/8306163 |
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| author | Krishi Peddada Nida M. Khan Jascha Rubin Haykanush Zakaryan Yaobin Liu Nikolay Popnikolov Roshun Sangani Weiye Li |
| author_facet | Krishi Peddada Nida M. Khan Jascha Rubin Haykanush Zakaryan Yaobin Liu Nikolay Popnikolov Roshun Sangani Weiye Li |
| author_sort | Krishi Peddada |
| collection | DOAJ |
| description | Diagnosing culture-proven endophthalmitis is complicated by the insufficient yield of intraocular samples and the variety of etiologies which mimic true endophthalmitis. In cases of impending vision loss where vitreous biopsy cannot provide a definitive diagnosis, transvitreal retinochoroidal biopsy can be an effective next step. Our case is a 48-year-old male with B-cell acute lymphoblastic leukemia that presented with counting fingers vision, redness, and tearing of the left eye. Exam showed cell and flare with hypopyon as well as dense vitritis. The patient underwent diagnostic pars plana vitrectomy and vitreous culture was negative at the time. Flow cytometry demonstrated no malignant cells. However, the patient’s vision and mental status continued to clinically decline despite being started on intravitreal and systemic antibiotic and antifungal therapy. Neuroimaging revealed rim-enhancing brain lesions. Transvitreal retinochoroidal biopsy was performed in an elevated area of the retina. The biopsy helped rule out malignancy and showed acute-angle, septate, branching hyphae characteristic of Aspergillus fumigatus. Ultimately, the vitreous biopsy, cultures, and a biopsy from the left frontal lobe brain abscess all confirmed this diagnosis as well. Transvitreal retinochoroidal biopsy can play a role in the diagnosis of a case of posterior uveitis and can be particularly effective in diagnosing a fungal endophthalmitis. |
| format | Article |
| id | doaj-art-7cf8d1d18c634eeb92af0c230eb4b291 |
| institution | Kabale University |
| issn | 2090-6722 2090-6730 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Ophthalmological Medicine |
| spelling | doaj-art-7cf8d1d18c634eeb92af0c230eb4b2912025-02-03T06:12:28ZengWileyCase Reports in Ophthalmological Medicine2090-67222090-67302018-01-01201810.1155/2018/83061638306163Diagnosis of Vitreoretinal Aspergillosis with Transvitreal Retinochoroidal BiopsyKrishi Peddada0Nida M. Khan1Jascha Rubin2Haykanush Zakaryan3Yaobin Liu4Nikolay Popnikolov5Roshun Sangani6Weiye Li7Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, PA, USADepartment of Ophthalmology, Drexel University College of Medicine, Philadelphia, PA, USARittenhouse Hematology/Oncology, Philadelphia, PA, USADepartment of Radiology, Drexel University College of Medicine, Philadelphia, PA, USADepartment of Pathology & Laboratory Medicine, Drexel University College of Medicine, Philadelphia, PA, USADepartment of Pathology & Laboratory Medicine, Drexel University College of Medicine, Philadelphia, PA, USADepartment of Ophthalmology, Drexel University College of Medicine, Philadelphia, PA, USADepartment of Ophthalmology, Drexel University College of Medicine, Philadelphia, PA, USADiagnosing culture-proven endophthalmitis is complicated by the insufficient yield of intraocular samples and the variety of etiologies which mimic true endophthalmitis. In cases of impending vision loss where vitreous biopsy cannot provide a definitive diagnosis, transvitreal retinochoroidal biopsy can be an effective next step. Our case is a 48-year-old male with B-cell acute lymphoblastic leukemia that presented with counting fingers vision, redness, and tearing of the left eye. Exam showed cell and flare with hypopyon as well as dense vitritis. The patient underwent diagnostic pars plana vitrectomy and vitreous culture was negative at the time. Flow cytometry demonstrated no malignant cells. However, the patient’s vision and mental status continued to clinically decline despite being started on intravitreal and systemic antibiotic and antifungal therapy. Neuroimaging revealed rim-enhancing brain lesions. Transvitreal retinochoroidal biopsy was performed in an elevated area of the retina. The biopsy helped rule out malignancy and showed acute-angle, septate, branching hyphae characteristic of Aspergillus fumigatus. Ultimately, the vitreous biopsy, cultures, and a biopsy from the left frontal lobe brain abscess all confirmed this diagnosis as well. Transvitreal retinochoroidal biopsy can play a role in the diagnosis of a case of posterior uveitis and can be particularly effective in diagnosing a fungal endophthalmitis.http://dx.doi.org/10.1155/2018/8306163 |
| spellingShingle | Krishi Peddada Nida M. Khan Jascha Rubin Haykanush Zakaryan Yaobin Liu Nikolay Popnikolov Roshun Sangani Weiye Li Diagnosis of Vitreoretinal Aspergillosis with Transvitreal Retinochoroidal Biopsy Case Reports in Ophthalmological Medicine |
| title | Diagnosis of Vitreoretinal Aspergillosis with Transvitreal Retinochoroidal Biopsy |
| title_full | Diagnosis of Vitreoretinal Aspergillosis with Transvitreal Retinochoroidal Biopsy |
| title_fullStr | Diagnosis of Vitreoretinal Aspergillosis with Transvitreal Retinochoroidal Biopsy |
| title_full_unstemmed | Diagnosis of Vitreoretinal Aspergillosis with Transvitreal Retinochoroidal Biopsy |
| title_short | Diagnosis of Vitreoretinal Aspergillosis with Transvitreal Retinochoroidal Biopsy |
| title_sort | diagnosis of vitreoretinal aspergillosis with transvitreal retinochoroidal biopsy |
| url | http://dx.doi.org/10.1155/2018/8306163 |
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