Aspergillus fumigatus scleritis associated with monoclonal gammopathy of undetermined significance

A 68-year-old woman presented with pain in her left eye. Necrosis with calcium plaques was observed on the medial part of the sclera. Aspergillus fumigatus was isolated from the culture of the necrotic area. On systemic work-up including serum and urine electrophoresis studies, the serum monoclonal...

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Bibliographic Details
Published in:Korean journal of ophthalmology 2010, 24(3), , pp.175-178
Main Authors: Jo, Dong Hyun, Oh, Joo Youn, Kim, Mee Kum, Heo, Jang Won, Lee, Jin Hak, Wee, Won Ryang
Format: Article
Language:English
Subjects:
Aged
Amphotericin B - administration & dosage
Antifungal Agents - administration & dosage
Aspergillosis - therapy
Aspergillus fumigatus
Case Report
Disease Progression
Eye Enucleation
Female
Humans
Injections, Intraocular
Paraproteinemias - complications
Sclera - diagnostic imaging
Sclera - pathology
Scleritis - complications
Scleritis - diagnosis
Scleritis - microbiology
Scleritis - physiopathology
Ultrasonography
Vitrectomy
안과학
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Summary:A 68-year-old woman presented with pain in her left eye. Necrosis with calcium plaques was observed on the medial part of the sclera. Aspergillus fumigatus was isolated from the culture of the necrotic area. On systemic work-up including serum and urine electrophoresis studies, the serum monoclonal protein of immunoglobulin G was detected. The patient was diagnosed with monoclonal gammopathy of undetermined significance and fungal scleritis. Despite intensive treatment with topical and oral antifungal agents, scleral inflammation and ulceration progressed, and scleral perforation and endophthalmitis developed. Debridement, antifungal irrigation, and tectonic scleral grafting were performed. The patient underwent a combined pars plana vitrectomy with an intravitreal injection of an antifungal agent. However, scleral and intraocular inflammation progressed, and the eye was enucleated. Aspergillus fumigatus was isolated from the cultures of the eviscerated materials. Giemsa staining of the excised sclera showed numerous fungal hyphae.
ISSN:1011-8942
2092-9382
DOI:10.3341/kjo.2010.24.3.175