Late-Onset Necrotizing Scleritis Due to Pigmented Mycetoma (Dematiaceous Fungi) in 2 Cases

Purpose: To describe the atypical presentation of fungal infection and necrotizing scleritis, the potential role of histopathology in the diagnosis, and surgical excision in the management. Methods: Retrospective interventional case series. Results: Two patients presented with a pigmented conjunctival mass, one resembling necrotizing scleritis with uveal prolapse and the other resembling a pigmented ocular surface tumor, both after excision of nasal pterygium, 12 and 50 years previously, respectively. The pigmented lesion was 2 × 1.5 mm in each case, both situated on the bulbar surface 2 mm from the nasal limbus. After surgical excision, each lesion histopathologically displayed fungal filaments (pigmented dematiaceous fungi). Conclusions: Pigmented mycetoma (dematiaceous fungi) can simulate uveal tissue prolapse, pigmented foreign body, or pigmented epibulbar tumors, particularly melanoma. Surgical excision of the entire lesion is effective for management.

[1]  Y. Ohashi,et al.  Autologous fascia lata grafts for scleral repair in eyes with infectious necrotizing scleritis. , 2011, Archives of ophthalmology.

[2]  David C Lung,et al.  Subconjunctival mycetoma as an unusual cause of tears with black deposits. , 2010, Archives of ophthalmology.

[3]  D. Jo,et al.  Aspergillus fumigatus Scleritis Associated with Monoclonal Gammopathy of Undetermined Significance , 2010, Korean journal of ophthalmology : KJO.

[4]  V. Jhanji,et al.  Scedosporium Scleritis or Keratitis or Both: Case Series , 2009, Eye & contact lens.

[5]  A. Galor,et al.  Subconjunctival Mycetoma After Sub-Tenon's Corticosteroid Injection , 2009, Cornea.

[6]  Sang Joon Lee,et al.  Topical and Oral Voriconazole in the Treatment of Fungal Keratitis , 2009, Korean journal of ophthalmology : KJO.

[7]  P. Garg,et al.  Microbial scleritis—experience from a developing country , 2009, Eye.

[8]  Yo-Chen Chang,et al.  Immunologic and Clinical Manifestations of Infectious Scleritis After Pterygium Excision , 2006, Cornea.

[9]  P. McCluskey,et al.  Scedosporium prolificans sclerokeratitis 10 years after pterygium excision with adjunctive mitomycin C , 2005, Clinical & experimental ophthalmology.

[10]  J. Giaconi,et al.  In vitro investigation of voriconazole susceptibility for keratitis and endophthalmitis fungal pathogens. , 2004, American journal of ophthalmology.

[11]  S. Ti,et al.  Tectonic corneal lamellar grafting for severe scleral melting after pterygium surgery. , 2003, Ophthalmology.

[12]  B. Haik,et al.  Conjunctival mycosis masquerading as melanoma. , 2002, American journal of ophthalmology-glaucoma.

[13]  D. H. Ma,et al.  Amniotic Membrane Graft for the Management of Scleral Melting and Corneal Perforation in Recalcitrant Infectious Scleral and Corneoscleral Ulcers , 2002, Cornea.

[14]  A. Espinel-Ingroff.  In Vitro Fungicidal Activities of Voriconazole, Itraconazole, and Amphotericin B against Opportunistic Moniliaceous and Dematiaceous Fungi , 2001, Journal of Clinical Microbiology.

[15]  G. Rao,et al.  Keratomycosis: clinical and microbiologic experience with dematiaceous fungi. , 2000, Ophthalmology.

[16]  S. Tseng,et al.  Management of infectious scleritis after pterygium excision. , 2000, Cornea.

[17]  C. Hsiao,et al.  Intrascleral dissemination of infectious scleritis following pterygium excision , 1998, The British journal of ophthalmology.

[18]  G. Spaeth,et al.  Early Successful Treatment of Postoperative Necrotizing Pseudomonas Scleritis after Trabeculectomy , 1997, Journal of glaucoma.

[19]  Chang-ping Lin,et al.  Clinical experiences of infectious scleral ulceration: a complication of pterygium operation , 1997, The British journal of ophthalmology.

[20]  C. Foster,et al.  Infectious posterior scleritis caused by Pseudallescheria boydii. Clinicopathologic findings. , 1997, Ophthalmology.

[21]  G. Crawford,et al.  Scedosporium prolificans corneoscleritis: a successful outcome. , 1997, Australian and New Zealand journal of ophthalmology.

[22]  M. E. Wilson,et al.  Periocular infection after strabismus surgery. The Periocular Infection Study Group. , 1995, Journal of pediatric ophthalmology and strabismus.

[23]  M. E. Wilson,et al.  Periocular infection after strabismus surgery. The Periocular Infection Study Group. , 1995, Journal of pediatric ophthalmology and strabismus.

[24]  I. Constable,et al.  Fungal corneoscleritis complicating beta-irradiation-induced scleral necrosis following pterygium excision , 1993, Eye.

[25]  M. Raizman,et al.  Six cases of scleritis associated with systemic infection. , 1992, American journal of ophthalmology.

[26]  E. Alfonso,et al.  Treatment of infectious scleritis and keratoscleritis. , 1991, American journal of ophthalmology.

[27]  R. E. Smith,et al.  Bacterial corneoscleritis complicating pterygium excision. , 1989, American journal of ophthalmology.

[28]  F. Polack,et al.  Aspergillus Panophthalmitis Complicating Treatment of Pterygium , 1988, Cornea.

[29]  J. Folk,et al.  Bacterial scleral abscesses after retinal buckling operations. Pathogenesis, management, and laboratory investigations. , 1987, Ophthalmology.

[30]  P. Laibson,et al.  Pseudomonas corneoscleral ulcers. , 1981, American journal of ophthalmology.

[31]  P. G. Watson,et al.  Scleritis and episcleritis. , 1976, The British journal of ophthalmology.

[32]  T. Suie,et al.  MYCOTIC INFECTION OF THE SCLERA. , 1964, American journal of ophthalmology.