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   Table of Contents      
Year : 1981  |  Volume : 29  |  Issue : 2  |  Page : 107-109

Ocular histoplasmosis

Department of Ophthalmology and Microbiology, Post-graduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
S P Dhir
Department of Ophthalmology and Microbiology, Post-graduate Institute of Medical Education and Research, Chandigarh 160012
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Source of Support: None, Conflict of Interest: None

PMID: 7327687

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How to cite this article:
Dhir S P, Talwar P, Jain I S. Ocular histoplasmosis. Indian J Ophthalmol 1981;29:107-9

How to cite this URL:
Dhir S P, Talwar P, Jain I S. Ocular histoplasmosis. Indian J Ophthalmol [serial online] 1981 [cited 2023 Nov 30];29:107-9. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1981/29/2/107/30975

Ocular histoplasmosis consists of a hae­morrhagic or non-haemorrhagic macular lesion with disciform detachment of the sensory retina, peripheral and peripapillary choroidal atrophic scars, and evidence of previous infec­tion of Histoplasma capsulatum. The syn­drome has a geographic predilection. In the United States, it seems to appear in an area corresponding to the area of greatest histoplas­min sensitivity[1].

Systemic histoplasmosis is endemic in the Ohio and middle Mississippi River valley of United States[2]. However, it is a rare disease in India. Only 20 authentic of histoplasmosis have been reported from different parts of the country[3]. No cases of ocular involvement due to histoplasmosis has been reported. The present report describes such a case.

  Case report Top

S.S. 25 years old male (A-036155) was seen with the complaints of defective vision from the left eye for the last two months. History revealed accidental detection of blurring of vision from left eye following closure of right eye. There was no history of any pain, redness or watering from the eye. There was no his­tory of trauma to the eye. Prior to examination he had recieved treatment in the form of cor­tico-steroides systemically and subconjunc­tivally for eleven days without any improve­ment of deterioration of vision. Concomi­tantly he also recieved Inj. Neurobion I/M daily for 11 days.

He gave no past history of respiratory pro­blem, diabetes mellitus or bowel complaints. He had malaria 5 months ago and received treatment in the form of chloroquin tablets and Inj. Chloroquin.

On examination no systemic abnormality was found and his blood pressure was 120/80 mm Hg.

Ocular examination revealed a normal right eye with a visual acuity of 6/6. Left eye showed subconjunctival haemorrhage (due to previous subconjunctival injection). Anterior segment was quiet. Pupil was larger than the right eye and reacted sluggishly to direct light. Consensual reaction was brisk. Fundus ex­amination revealed a clear media with normal optic disc and periphery. Macular area showed serous detachment with gross oedema and radial folds around the fovea. A dense yellowish spot could be barely made out below the macula [Figure - 1]. Fluorescein angio­graphy showed a small triangular hyper fluorescent patch below and temporal to the fovea. A small neovascular membrane was seen below this patch [Figure - 2]. There was pro­gressive leakage of the dye from the neova­scular membrane and from the triangular hyper-fluorescent patch which changed its size and configuration [Figure - 3]. The overlying reti­nal capillary network was normal. Central field examination showed a peracentral sco­toma in the upper temporal quadrant involv­ing the fixation spot.

Laboratory investigations showed a normal haemogram, blood count and E.S.R. of 2 mm. Stool examination revealed presence of en­tamoeba histolytica cyst and E.Coli. X-ray chest showed normal lung fields with enlarge­ment of heart size. Serology for histoplas­mosis was strongly positive by immuno-preci­pitation by gel diffussion technique[4]. The his­toplasma antigen for immunodiffusion test was obtained from Microbiological Associates Bethsda, Margland, U.S.A.

The Serological tests by immuno-diffusion for blastomycosis, aspergillosis and candi­diasis using cystoplasmic extract were nega­tive.

  Discussion Top

The diagnosis of ocular histoplasmosis is largely presumptive. It is based on the clini­cal picture and evidence of previous infection with histoplasma capsulatum, usually in the form of a positive histoplasma skin test. The clinical suspicion was fairly strong in the pre­sent patient. A youngman with disciform ac­tive lesion on the macula, clear media, demons­tration of histo spot and neovascular mem­brane with fluorescin angiography and tolerance of heavy dosages of corticosteroids with­out aggravation of the clinical picture in this patient are all the characteristics which are seen in ocular histoplasmosis. However we do have another patient with all the above characteristics and a negative histo­plasma serology.

The rarity of this condition in India is understandable as there are only some 20 cases of known histoplasmosis reported in the country and none with ocular involvement. Studies of patients with chronic and acute pulmonary histoplasmosis have failed to reveal any ocular changes over those that are to be expected in a control group[1],[5]. In the present patient also no active palmonary focus was detected. The eye involvement seems to follow a benign systemic histoplasmosis as evident from the postive serological immuno-precipta­tion in gel diffusion test in the present patient.

Inspite of strong circumstantial clinical evidence, the pathogenesis of this disorder has remained unresolved. Focal granuloma­tous choroiditis has been produced in rabbits experimentally infected systemically with spores of histoplasma capsulatum[6]. Focal chorio-retinal lesion by histoplasma capsulatum have also been produced in rabbits by supra-choroidal inoculation[7]. Bhatia et al[8] in a study of histoplasmin skin test in India observed that the centrol group showed 6.7% of positive reactors while uveitis patients showed 7.14% of positive reactors. Histo­plasma infection is uncommon in India and ocular involvement is extremely rare. However serological testing of clinically promising pa­tients may yield more cases of this syndrome.

  Summary Top

A young man of 25 years age with disci­form lesion of the macula in left eye and a positive serology for histoplasmosis is repor­ted.

  References Top

Schlaegel, T.F., 1975, Internal Ophthalmic Clinics, 15: 1.  Back to cited text no. 1
Edwards, L.G., Acquaviva, F.A.. Livesay. V.T., Cross, F.W., and Palmer, C.E., 1969, Amer. Rev. Respir. Des. 99: 14.  Back to cited text no. 2
Talwar, P., Mishra. S.S. and Dash, R.J., 1978, Ind. J. Bathol. Microbiol. 21 :357.  Back to cited text no. 3
Ouchterlony, O., 1953, Acta Pathol. Microbio. Scand. 32 :232.  Back to cited text no. 4
Davidorf, F.H., and Anderson, J.D., 1974, Trans. Amer Acad. Ophthalmol. Otolaryngol. 78:876.  Back to cited text no. 5
Wong, W.R., Anderson, R.R., Collins, E.M. and Hill, W.B., 1972, Trans. Amer. Acad. Ophthal­mol Otoleryngol, 77 :769.  Back to cited text no. 6
Mohan, M; Mazumder, A; Batta, R.K., Mahajan, V.M., and Goswamy. V., 1978, East. Arch. Ophthalmol. 6 : 23.  Back to cited text no. 7
Bhatia, R.P.S., Mehra, K.S., and Tewari, A.K. 1980. Ind. J. Ophthalmol 28:9.  Back to cited text no. 8


  [Figure - 1], [Figure - 2], [Figure - 3]


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