Aspergillus iris granuloma: a case report with review of literature

Surv Ophthalmol. Mar-Apr 2009;54(2):286-91. doi: 10.1016/j.survophthal.2008.12.008.

Abstract

We report the case of a 25-year-old male patient who presented with complaints of redness, photophobia, and decreased vision in the right eye of a week's duration. Slit-lamp biomicroscopic examination revealed a cream-colored, irregular elevated inferior iris mass, extending on to the anterior lens surface. Differential diagnoses of a fungal granuloma, a medulloepithelioma, and an amelanotic melanoma were considered. An excisional biopsy of the mass was performed through a superior clear corneal incision. Polymerase chain reaction analysis of the aqueous humor showed a positive pan fungal genome. Histopathology of the biopsied mass showed a giant cell granuloma with surrounding numerous branching, septate hyphae. Culture growth revealed Aspergillus fumigatus We report this case because of the rarity of Aspergillus iris granuloma as a primary presentation of endogenous Aspergillosis and review the relevant literature. Absence of a significant systemic history compounded the diagnostic dilemma in our patient. Definitive differentiation of this rare entity from a foreign body, amelanotic melanoma, and other inflammatory conditions such as sarcoidosis and tuberculosis, may be possible only on microbiological and histo-pathological evaluation.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Antifungal Agents / therapeutic use
  • Aqueous Humor / microbiology
  • Aspergillosis / diagnosis
  • Aspergillosis / drug therapy
  • Aspergillosis / microbiology*
  • Aspergillus fumigatus / genetics
  • Aspergillus fumigatus / isolation & purification*
  • Atropine / therapeutic use
  • Aza Compounds / therapeutic use
  • DNA, Fungal / analysis
  • Drug Therapy, Combination
  • Eye Infections, Fungal / diagnosis
  • Eye Infections, Fungal / drug therapy
  • Eye Infections, Fungal / microbiology*
  • Fluoroquinolones
  • Genome, Fungal / genetics
  • Granuloma, Giant Cell / diagnosis
  • Granuloma, Giant Cell / drug therapy
  • Granuloma, Giant Cell / microbiology*
  • Humans
  • Iris Diseases / diagnosis
  • Iris Diseases / drug therapy
  • Iris Diseases / microbiology*
  • Male
  • Moxifloxacin
  • Natamycin / therapeutic use
  • Polymerase Chain Reaction
  • Quinolines / therapeutic use

Substances

  • Antifungal Agents
  • Aza Compounds
  • DNA, Fungal
  • Fluoroquinolones
  • Quinolines
  • Atropine
  • Natamycin
  • Moxifloxacin