Abstract

Introduction: Histoplasmosis is a systemic mycosis present in an endemic state in many tropical or temperate regions. It is a pathology induced by Histoplasma capsulatum, dimorphic fungus thriving in wetlands and at moderate temperatures. In immunocompetent subjects, 95% of clinical forms are asymptomatic. The preferred sites for this dissemination are pulmonary, medullary, hepatic, splenic and ganglionic. Exceptionally, the fungus can reach the eye.

Materials and methods: We report a case of ocular histoplasmosis in a 62-year-old patient.

Observation: It is a patient aged 62 years, diabetic under insulin for 5 months (discovery inaugural), amputated on the right side for a diabetic foot in October 2016, which showed a decrease in visual acuity appeared for 5 months. A complete ophthalmologic examination was carried out as part of the degenerative assessment of his diabetes, and he objectified: visual acuity at 1/10 at right eye, 2/10 at left, ocular tone at 16Mmhg at right eye and 14mmhg at left , biomicroscopic examination did’nt find tyndall in the anterior chamber, examination in the The bottom of eye showed: the presence of choroidal depigmented white at the retinal periphery with blamed haemorrhages, the absence of inflammation and inflammatory cells in the vitreous in both eyes, and the presence of peripapillary atrophy in the left eye.

Discussion: Ocular histoplasmosis syndrome (SS) is a deep mycosis with a pulmonary entry portal characterized by chorio retinal disorder caused by Histoplasma capsulatum, which is commonly found in endemic areas. The ocular damage remains quite exceptional since only 1.6 to 5.3% of patients with histoplasmosis are affected. The diagnosis of ocular histoplasmosis is made by clinical examination. The fundus of the eye can find histo spots, peripapillary atrophy, macular disciform lesions active or not and never finds inflammatory cells in the vitreous and the anterior segment. The systemic antifungal treatments used in the treatment of histoplasmosis have little use in the treatment of ophthalmologic involvement because the fungus does not appear to be in the eye at the time of ophthalmologic diagnosis. The treatment of eye damage is therefore very specific.

Conclusion: Ocular histoplasmosis is a fungal infection that has long been underestimated because of the asymptomatic or benign character of the primary infection. Indeed, this ophthalmological pathology, of random evolution and with heavy clinical consequences, is very little known and rarely sought, whereas an early diagnosis improves its management and hence its functional prognosis.

Keywords: Ocular; Histoplasmosis; Histo spots; Peripapillary atrophy; Neovascularization; Systemic antifungal treatments