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Clinical and histopathologic ocular findings in disseminated infection with mycobacterium chimaera

Session Details

Session Title: Uveitis

Session Date/Time: Saturday 19/09/2015 | 11:00-12:30

Paper Time: 12:04

Venue: Hermes

First Author: : S.Zweifel SWITZERLAND

Co Author(s): :    D. MihicProbst   D. Barthelmes   B. Hasse   P. Kohler   R. Eberhard   C. Boeni

Abstract Details

PURPOSE:To investigate and characterize clinical and histopathological findings in the posterior segment of the eye due to infection with Mycobacterium chimaera, a slowly growing nontuberculous mycobacterium (NTM).

Setting:

Retrospective single center case series

Methods:

Retrospective analysis of clinical ocular findings including visual acuity, slit-lamp biomicroscopy, spectral domain optical coherence tomography (SD-OCT), fundus autofluorescence (FAF) and fluorescein (FA)/indodyanine green (ICG) angiography findings of patients with a disseminated M. chimaera infection. Biomicroscopic and multimodal imaging findings were compared with histopathologic findings.

Results:

Five Caucasian patients (10 eyes) with a mean age of 57.8 years were analysed. All patients were diagnosed with either endocarditis and/or aortic graft infection. Two patients died due to systemic complications related to uncontrolled M. chimaera infection despite being under antimicrobial therapy. Ocular tissues were obtained from one patient during autopsy. Ocular findings included mild anterior uveitis, optic disc edema and yellowish-white choroidal lesions. The multifocal choroidal lesions observed bilaterally in all patients were hyperfluorescent in FA, hypofluorescent in ICG and were correlated with choroidal lesions in the SD-OCT. The extent of the choroidal lesions varied from few choroidal lesions in two patients to widespread miliary lesions in three patients leading to localized elevation of the overlying retinal layers. SD-OCT imaging through lesions in regression revealed altered outer retinal layers with underlying choroidal hyperreflectivity. No subretinal fluid accumulation could be detected in any of the eyes. Necropsy of the eyes revealed prominent granulomatous lymphoplasmocellular choroiditis with giant cells. Quantitative polymerase chain reaction analysis did not detect M. chimaera in ocular tissue.

Conclusions:

NTM infections are very rare, the diagnosis is often delayed. Systemic infection with M. chimaera may result in severe retinal and choroidal changes, which has not been described before. Whether these changes are infective per se or represent a hypersensitivity response to M.chimaera remain speculative. However these ocular manifestations are good indicators of the systemic control of the disease process.

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