Anterior Uveitis as a Rare Presentation of Ocular Sporotrichosis

Abstract

Introduction: Sporotrichosis is a chronic granulomatous mycotic infection caused by Sporothrix schenckii. Anterior uveitis is a rare presentation of ocular sporotrichosis. Objective: To report a case of severe anterior uveitis as a rare presentation of ocular sporotrichosis. Case report: A 53-year-old Malay woman, presented with painful, redness, and photophobia of the right eye for 1 week. It was associated with mucopurulent discharge and blurry of vision. She had cats at home but no history of cat bites. Right eye visual acuity was 6/18 and improved to 6/9 with pinhole. There was presence of multifocal area of granulomatous conjunctival lesions with severe anterior uveitis and streak of hypopyon. Pupil was irregular with posterior synechiae. Blood investigations for infective causes and connective tissue screening were negative. Mucopurulent ocular discharge swab yields no growth. An initial diagnosis of severe anterior uveitis was made, which was treated with steroid and antibiotic eye drops.  However, the symptoms persisted after 1 week of treatment.  A clinical diagnosis of ocular sporotrichosis of conjunctiva with anterior uveitis was revised based on the presence of granulomatous conjunctival lesions. She was treated empirically with tablet itraconazole 100 mg twice per day for 6 weeks. The right eye visual acuity improved significantly, granulomatous conjunctival lesions regressed, and resolved inflammation in the anterior chamber.Conclusion: Ocular sporotrichosis is common in tropic area thus high index of suspicion should be made even culture was negative.