Which clinical history findings are characteristic of ocular histoplasma chorioretinitis in HIV infection?

Updated: Jun 12, 2019
  • Author: Robert A Copeland, Jr, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Answer

The typical triad of ocular histoplasmosis syndrome comprises the following:

  • Yellowish-white, punched-out circular lesions (“histo spots”) scattered in the fundus

  • A macular choroidal neovascular membrane (CNVM), seen as a grayish-green patch underneath the retina

  • One or more areas of atrophy or scarring adjacent to the optic disc

A pigmented rim separating the disc from the area of atrophy or scarring may be present. The formed macular CNVM may be associated with retinal neurosensory detachment, subretinal blood or exudate, or a pigmented ring evolving into a disciform scar.

In children, histoplasmosis often manifests as disseminated disease, with fever, hepatosplenomegaly, nausea, vomiting, diarrhea, and weight loss. Interstitial pneumonia is expected to develop within a few weeks and may be fatal if not treated aggressively.

Adults with disseminated histoplasmosis often present with fever and acute pneumonia. The central nervous system, kidneys, and GI tract often are involved secondarily.

Ocular involvement in disseminated histoplasmosis may include retinitis, choroiditis, optic neuritis, or uveitis. The retinitis often appears as discrete multiple, yellowish-white intraretinal and subretinal infiltrates, approximately one-fourth to one-sixth disc diameter. The granulomatous choroiditis of histoplasmosis may appear as small white drusenoid bodies.

The disease rarely is diagnosed acutely but most commonly is recognized by the clinical appearance of the lesion. Patients often are diagnosed with ocular histoplasmosis following the development of choroidal neovascularization leading to significant loss of central vision.

During acute illness from disseminated histoplasmosis, diagnosis can be made from positive blood cultures and cultures of urine, mouth ulcers, and/or tissue biopsies. Liver biopsies have been reported to be positive for Histoplasma capsulatum in as many as 80% of patients. A high fixation titer for histoplasmin complement substantiates the diagnosis. Immunodefective patients may have a negative histoplasmin skin test. The vitreous aspirates obtained during pars plana vitrectomy may be used to isolate the organisms.


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