amphotericin-b and Choroid-Diseases

Coccidioides immitis is a dimorphic fungus endemic to the arid climates of the Southwest United States, Mexico and parts of Central and South America. Human infection occurs through inhalation of spores with less than half of exposures progressing to a symptomatic state that primarily consists of pulmonary manifestations. Disseminated coccidioidomycosis is exceedingly rare, occurring in fewer than 1 % of symptomatic infections. Through hematogenous spread, the fungus can infect most organ systems and may be fatal without systemic antifungal treatment. Individuals with impaired cell-mediated immunity either from primary immunodeficiency disorders or secondary to immunosuppression with medications such as tumor necrosis factor alpha (TNF-α) inhibitors have increased risk of disseminated coccidioidomycosis and previous cases of coccidioidomycosis have been reported with biologic therapy.. We present a case of disseminated coccidioidomycosis in a 16-year-old female with polyarticular juvenile idiopathic arthritis (JIA) being treated with prednisone, methotrexate, and infliximab. The patient presented with symptoms of meningeal irritation, bilateral choroidal lesions, and necrotizing peripheral pneumonia. Her infection was thought to be a reactivation of coccidioidomycosis given her history of resolved pneumonia that occurred after traveling to Arizona, New Mexico, and El Paso one year prior to presentation. Following diagnosis, she improved with discontinuation of her immunosuppressive medications and two weeks of intravenous amphotericin B and fluconazole with plans for lifetime treatment with fluconazole while immunosuppressed. Due to worsening arthritis, she will begin tofacitinib and continue close monitoring of chest x-rays and coccidioides antibody.. Patients undergoing immunosuppressive therapy for rheumatological conditions are at increased risk of disseminated coccidioidomycosis and should be evaluated with high suspicion when presenting with atypical symptoms and history of travel to endemic regions.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Antirheumatic Agents; Arthritis; Arthritis, Juvenile; Choroid Diseases; Coccidioides; Coccidioidomycosis; Disease Progression; Female; Fluconazole; Humans; Immune Tolerance; Infliximab; Meningitis, Fungal; Monitoring, Immunologic; Pneumonia, Necrotizing; Treatment Outcome

Topics: Abscess; Amikacin; Amphotericin B; Cefotaxime; Choroid Diseases; Drug Therapy, Combination; Eye Infections, Bacterial; Fluorescein Angiography; Humans; Kidney Transplantation; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Transplantation, Homologous; Trimethoprim, Sulfamethoxazole Drug Combination; Vitreous Body

To review the presentation and course of choroidal blastomycosis, a rare chorioretinal mycotic infection, which results from disseminated blastomycosis.. Two cases of disseminated blastomycosis with ocular infection limited to the choroid are presented. Each patient was diagnosed through biopsy of skin lesions demonstrating the characteristic histologic features and the budding yeast.. Systemic evaluation revealed extensive disseminated disease with involvement of the eye, lung, skin, bone and joint, central nervous system, and genitourinary system. Both patients were successfully treated with intravenous amphotericin B with elimination of ocular and systemic disease.. Although rare, blastomycosis can result in choroidal mycotic infection in immune competent individuals. Tissue biopsy to confirm the diagnosis and extensive systemic evaluation are required.

Topics: Adult; Amphotericin B; Blastomyces; Blastomycosis; Brain Diseases; Choroid; Choroid Diseases; Dermatomycoses; Eye Infections, Fungal; Female; Fundus Oculi; Hand; Humans; Infusions, Intravenous; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Skin; Tomography, X-Ray Computed

A 30-year-old patient with the acquired immunodeficiency syndrome (AIDS) had limbal nodules and multifocal choroidal lesions.. A biopsy of the limbal nodules was performed.. The biopsy showed Cryptococcus neoformans surrounded by thick mucinous capsules without inflammatory cell infiltration.. In the differential diagnosis of limbal mass in patients with AIDS, cryptococcal infection should be considered.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Choroid Diseases; Choroiditis; Corneal Diseases; Cryptococcosis; Cryptococcus neoformans; Diagnosis, Differential; Eye Infections, Fungal; Humans; Limbus Corneae; Male; Retinal Hemorrhage