Abstract
Blastomycosis is a systemic pyogranulomatous infection caused by the thermally dimorphic fungus Blastomyces dermatitidis. The annual incidence in endemic areas is estimated to be less than 1 case per 100,000 people. Original infection occurs after the inhalation of conidia (spores), resulting in a pulmonary disease after a 3–6-week incubation period. Extrapulmonary disease occurs in up to 40% of patients. Ophthalmic infections are rare and require prompt diagnosis, as untreated infections can result in rapid and complete vision loss. The diagnosis requires a biopsy or culture of affected tissues, and microscopic examination can reveal yeast forms with characteristic broad-based budding and granulomatous changes. The most common ocular manifestations are that of uveitis – specifically iridocyclitis, choroiditis, endophthalmitis, and panophthalmitis. Common symptoms include photophobia, decreased visual acuity, and visual field deficits. Anterior segment findings include corneal opacification, anterior chamber reaction, iris mass or abscess, and clouding of the lens. Funduscopic examination can reveal vitreous haze and yellow or yellow-white elevated choroidal lesions that can range from 0.125 to 8 disc diameters in size. Diagnostic evaluation may include echography, fluorescein angiography, and imaging of the orbits. Ancillary testing should include imaging to evaluate for pulmonary lesions. Current standard of care relies on local therapy and systemic antifungals, including oral azoles and intravenous amphotericin B for any patient with central nervous system (CNS) involvement.
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Almony A, Kraus CL, Apte RS. Successful treatment of choroidal blastomycosis with oral administration of voriconazole. Can J Ophthalmol. 2009;44(3):334–5.
Altman JS, Tonelli DG, Bukhalo M. Red, scaly lesion on the upper eyelid. Am Fam Physician. 2007;76(10):1533–4.
Arevalo JF. Retinal and choroidal manifestations of selected systemic diseases. New York: Springer; 2013. p. 185–6.
Bond WI, Sanders CV, Joffe L, Franklin RM. Presumed blastomycosis endophthalmitis. Ann Ophthalmol. 1982;14(12):1183–8.
Cassady JV. Uveal blastomycosis. Arch Ophthal. 1946;35:84–97.
Chapman SW, Bradsher RW, Campbell GD, Pappas PG, Kauffman CA. Practice guidelines for the management of patients with blastomycosis Infectious Diseases Society of America. Clin Infect Dis. 2000;30(4):679–83.
Chapman SW, Dismukes WE, Proia LA, et al. Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(12):1801–12.
Churchill FSA. A case of systemic blastomycosis. Arch Intern Med. 1914;13:568.
Font RL, Spaulding AG, Green WR. Endogenous mycotic panophthalmitis caused by blastomyces dermatitidis. Report of a case and a review of the literature. Arch Ophthalmol. 1967;77(2):217–22.
Garg A. Ocular therapeutics. New Delhi: Jaypee Brothers Medical Pub; 2013. p. 229–30.
Gilchrist TC, Stokes WR. The presence of an Oidium in the tissues of a case of pseudo-lupus vulgaris. Bull Johns Hopkins Hosp. 1896;7:129.
Gonyea EF. The spectrum of primary blastomycotic meningitis: a review of central nervous system blastomycosis. Ann Neurol. 1978;3(1):26–39.
Gottlieb JL, McAllister IL, Guttman FA, Vine AK. Choroidal blastomycosis. A report of two cases. Retina. 1995;15(3):248–52.
Hariprasad SM, Mieler WF, Holz ER, et al. Determination of vitreous, aqueous, and plasma concentration of orally administered voriconazole in humans. Arch Ophthalmol. 2004;122(1):42–7.
Klein BS, Vergeront JM, Davis JP. Epidemiologic aspects of blastomycosis, the enigmatic systemic mycosis. Semin Respir Infect. 1986;1(1):29–39.
Lewis H, Aaberg TM, Fary DR, Stevens TS. Latent disseminated blastomycosis with choroidal involvement. Arch Ophthalmol. 1988;106(4):527–30.
Li S, Perlman JI, Edward DP, Weiss R. Unilateral Blastomyces dermatitidis endophthalmitis and orbital cellulitis. A case report and literature review. Ophthalmology. 1998;105(8):1466–70.
Lopez R, Mason JO, Parker JS, Pappas PG. Intraocular blastomycosis: case report and review. Clin Infect Dis. 1994;18(5):805–7.
McKee SH. Blastomycosis of the eye. Can Med Assoc J. 1930;22(4):501–3.
Pariseau B, Lucarelli MJ, Appen RE. Unilateral Blastomyces dermatitidis optic neuropathy case report and systematic literature review. Ophthalmology. 2007;114(11):2090–4.
Patel AJ, Gattuso P, Reddy VB. Diagnosis of blastomycosis in surgical pathology and cytopathology: correlation with microbiologic culture. Am J Surg Pathol. 2010;34(2):256–61.
Phelps PO, Seagrave Z, Williams KM. Blastomycosis in the eyelid of a native Chicagoan. Ophthalmology. 2015;122(5):1015.
Rodriguez RC, Cornock E, White VA, Dolman PJ. Eyelid blastomycosis in British Columbia. Can J Ophthalmol (J Can d’Ophtalmol). 2012;47(3):e1–2.
Roy FH, Fraunfelder FT. Roy and Fraunfelder’s current ocular therapy. Philadelphia: PA Saunders Elsevier; 2008. p. 14–5.
Safneck JR, Hogg GR, Napier LB. Endophthalmitis due to Blastomyces dermatitidis. Case report and review of the literature. Ophthalmology. 1990;97(2):212–6.
Sinskey RM, Anderson WB. Miliary blastomycosis with metastatic spread to posterior uvea of both eyes. AMA Archi Ophthalmol. 1955;54(4):602–4.
Vida L, Moel SA. Systemic North American blastomycosis with orbital involvement. Am J Ophthalmol. 1974;77(2):240–2.
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Fathy, C.A., Jonna, G., Agarwal, A. (2018). Blastomycosis. In: Gupta, V., Nguyen, Q., LeHoang, P., Agarwal, A. (eds) The Uveitis Atlas. Springer, New Delhi. https://doi.org/10.1007/978-81-322-2506-5_42-1
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DOI: https://doi.org/10.1007/978-81-322-2506-5_42-1
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