A Case of Chrysosporium Parvum Endophthalmitis

PURPOSE: To report a case of Chrysosporium parvum endophthalmitis after trauma. METHODS: A 42-year-old healthy woman visited our hospital complaining of ocular pain after trauma sustained with a wire used to tie grapes. She showed corneal laceration and iris prolapse of the right eye on slit lamp examination. She underwent primary suture of the corneal laceration. Two days later, she presented with hypopyon of the anterior chamber. She was treated with topical antibiotics and a topical steroid. On follow-up examination, she again presented with hypopyon of the anterior chamber. She was admitted for microbiologic examination and was again treated with topical antibiotics and a topical steroid. Unfortunately, no organisms were identified by culture. Later, she reported a recurrent history of the inflammation. After 9 months, she presented with increased hypopyon of the anterior chamber and was treated with anterior chamber irrigation and intracameral antibiotics injection on two different occasions. But, still no organisams were identified. After one year, the patient visited our clinic with ocular pain and decreased visual acuity. Her intraocular pressure was 72 mmHg and there was whitish infiltration and hypopyon around 360 degrees of the anterior chamber and angle. At the same time, the intraocular pressure and inflammation were uncontrolled. Ultimately, microscopic examination of specimens obtained directly from tissue after enucleation identified the organism as Chrysosporium parvum. CONCLUSIONS: We experienced a case of Chrysosporium parvum endophthalmitis after trauma. To our knowledge, this was the first report of a case of Chrysosporium parvum endophthalmitis in the world.

Adiaspiromicose humana: relato de um caso tratado com cetoconazol / Human adiaspiromycosis. A report of a case treated with ketoconazole

É descrito um caso de adiaspiromicose humana, da forma pulmonar disseminada, no qual se empregou o cetoconazol. O paciente, oriundo de Goianésia, GO, referia tosse produtiva, dispnéia e emagrecimento. Doente há dois meses, já fizera uso do esquema tríplice tuberculostático, devido a um radiograma do tórax ter acusado lesões sugestivas de tuberculose miliar. Esse tratamento não surtiu o efeito esperado, pelo que foi ele submetido a uma biópsia pulmonar a céu aberto. A medida permitiu o reconhecimento da natureza fúngica da doença. Passou-se, então, ao emprego do cetoconazol, quando o processo já completara três meses de evolução. Dois meses depois, foi o paciente novamente visto, para controle do tratamento: todas as manifestações respiratórias haviam cessado e um novo radiograma mostrou regressão completa das alterações pulmonares. Apesar disso, é discutida a eficácia do cetoconazol contra C. parvum var crescens, tendo-se em conta o fato de o microrganismo não se reproduzir no hospedeiro.

A case of human disseminated pulmonary adiaspiromycosis is reported. The patient, from Goianésia, GO, was admitted to the Brasilia University Hospital, in November 1992, with wet cough, dyspnea and weight loss--manifestations that had appeared two months before. Prior to admission, he had been treated for a suspected miliary tuberculosis, because a chest roentgenogram had shown a diffuse reticulonodular infiltrate in both lungs. This therapy brought no improvement to the patient status. An open chest biopsy was then performed, and the microscopic examination of the lung tissue revealed the fungal nature of the disease. Ketoconazole, 400mg/day, was started and the patient discharged from the hospital. He was seen again two months later: the respiratory manifestations had disappeared and a new chest roentgenogram showed complete resolution of the pulmonary lesions. The usefulness of ketoconazole is, however, questioned, since, as there is no multiplication of the fungus in the host organism--adiaspiromycosis is believed to be, usually, a self-healing disease--the efficacy of this imidazole derivative against the agent in animal tissues remains to be confirmed.

Adiaspiromicose pulmonar disseminada: relato de caso / Disseminated pulmonary adiaspiromycosis: a case report

Relata-se caso de adiaspiromicose causando infiltrado pulmonar retículo-nodular difuso e bilateral, em lavrador de 26 anos. O diagnóstico etiológico foi estabelecido através de biópsia por toracoscopia. Tratado com cetoconazol, o paciente evoluiu bem, retornando às atividades profissionais um mês após a alta.

A case of thoracoscopic lung biopsy proven diffuse human adiaspiromycosis is reported. The patient, a 26-year-old male farm worker presented with a three-week history of fever, sweating, dyspnea and unproductive cough. Radiographic findings were those of granulomatous pulmonary interstitial disease. Treated with ketoconazole he improved very well, resuming work normal activities a month later.