A Case of Endogenous Aspergillus Endophthalmitis Associated with Mycotic Cerebral Aneurysm

Sinwoo Bae; Ju Byung Chae

doi:10.3341/jkos.2011.52.10.1249

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Bae and Chae: A Case of Endogenous Aspergillus Endophthalmitis Associated with Mycotic Cerebral Aneurysm

Original Article

J Korean Ophthalmol Soc 2011;52(10):1249-1253.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.10.1249

A Case of Endogenous Aspergillus Endophthalmitis Associated with Mycotic Cerebral Aneurysm

Sinwoo Bae, MD, Ju Byung Chae, MD

Department of Ophthalmology, College of Medicine, Chungbuk National University, Cheongju, Korea

Address reprint requests to Ju Byung Chae, MD Department of Ophthalmology, Chungbuk National University Hospital #410 Seongbong-ro, Heungdeok-gu, Cheongju 361-711, Korea Tel: 82-43-269-6333, Fax: 82-43-264-5263, E-mail: jbchae@chungbuk.ac.kr

Received 2 November 2010 Accepted 14 March 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of a endogenous Aspergillus endophthalmitis associated with mycotic cerebral aneurysmal rupture.

Case summary

A 51-year-old woman was referred to our retina clinic for decreased visual acuity in the left eye. The patient had previously undergone a liver transplant for liver cirrhosis and hepatocellular carcinoma. On fundus examination, vitreous opacities with a yellowish-white subretinal abscess were observed. There were no abnormal findings except the positive sign in the laboratory serum Aspergillus antigen test performed on admission. Based on the suspicion of endogenous endophthalmitis, pars plana vitrectomy was performed with intravitreal antibiotics injection to treat fungal and bacterial infections. There was no growth in either the vitreous or anterior chamber culture. After vitrectomy, visual acuity improved and the inflammation subsided. However, by the three-week follow-up, acute-onset left hemiplegia with a right hemisphere cerebral hemorrhage had occurred. Cerebral magnetic resonance angiography showed multiple mycotic aneurysms characterized by a large and fusiform appearance. The patient was treated with neuro-emboli-zation and was stabilized with minimal sequalae.

Conclusions

Although the immunocompromised endophthalmitis patient can be treated using proper management, brain lesions such as mycotic aneurysm may exist and should be carefully considered.

Keywords: Aneurysm, Aspergillus, Endophthalmitis

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Figure 1.

Fundus photograph shows massive vitreous opacity with yellow-whitish subretinal abscess in the left eye, there was no inflammatory sign in the right eye. The visual acuity was 20/20 in the right eye, and hand movement in the left eye.

Figure 2.

B-scan ultrasonograph shows dense posterior vitreous opacification with abnormal vitreous spikes in the left eye.

Figure 3.

Two weeks later, the visual acuity improved from hand movement to 20/400; there was no active inflammatory sign in the left eye.

Figure 4.

Three weeks after pars plana vitrectomy, left side weakness in the left hand and foot was detected. On computer tomography, intracranial cerebral hemorrhage was detected in the right hemisphere.

Figure 5.

On four vessel angiography (left) and three dimensionalabsorbed angiography (right), there are multiple, large, and fusiform mycotic aneurysms are demonstrated (arrows), Angio-guided neuro-emboli-zations were performed to close the aneurysms successfully.

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