Aspergillus necrotizing retinitis. A clinico-pathologic study and review.

The authors describe a case of bilateral acute necrotizing retinitis caused by Aspergillus fumigatus in an immunocompromised host. The patient rapidly lose useful vision and expired from progressive systemic disease while on parenteral amphotericin B. Postmortem aqueous cultures were negative whereas vitreous cultures were positive. Light and electron microscopy demonstrated marked choroidal and retinal vascular occlusion by fungi and thrombi, hyphae extending through vessel walls and the internal limiting membrane of the retina, fungi accumulating in tissue spaces, hyphae on the iris surface, and necrosis of the retina. In view of the extensive vascular occlusion present in this disease, early diagnostic vitrectomy plus intravitreal amphotericin B is recommended to deliver adequate drug levels to infected sites.