Necrotizing choroiditis-retinitis as presenting symptom of disseminated aspergillosis after lung transplantation

Background. Endogenous endophthalmitis due to Aspergillus is rare affecting the severely immunosuppressed population, in particular recipients of heart and lung transplants. Ocular involvement of aspergillosis has always been observed late in the course of the disease. Subject. A young woman noted blurred vision in one eye three weeks after lung transplantation. At this stage, no systemic manifestations of fungal infection were detected and the ocular findings were attributed to viral infection. Results. Twenty-four hours after the original ocular complaint, an aggressive endophthalmitis developed in the left eye. The possibility of fungal endophthalmitis was raised. Within 48 hours of her first ocular complaint the patient died. Cultures from a vitreous tap and from autopsy ocular specimens were positive for Aspergillus fumigatus. Conclusions. Aspergillus endophthalmitis may occur in patients undergoing lung transplantation despite antifungal therapy. Increased awareness of this unusual entity may be life and vision saving in these patients.