Case Study: April 2008

History

A painful, red, blind eye was enucleated from a diabetic patient with a nasal mass.

Figure 1 shows the retina-RPE-choroid.

Figure 2 is a silver stain of the retina.

Questions

1. What does figure 1 show?
2. What does figure 2 show?
3. Given the history what is the likeliest diagnosis in this case?

Click to show answers
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1. Retinal and choroidal necrosis. Note how intact the RPE looks.
2. Fungal hypha-most of them were non-septate and rather irregular.
3. Mucormycosis endophthalmitis. The sclera and medial orbital wall were intact, implying that the endophthalmitis was probably metastatic.

References

Bhansali A, Sharma A, Kashyap A, Gupta A, Dash RJ.Mucor endophthalmitis.
Acta Ophthalmol Scand. 2001 Feb;79(1):88-90.

Wipf JE, Paauw DS.Ophthalmologic emergencies in the patient with diabetes.
Endocrinol Metab Clin North Am. 2000 Dec;29(4):813-29. Review.