Presumed ocular histoplasmosis in The Netherlands--an area without histoplasmosis

Abstract

Aims/background: The syndrome of ocular histoplasmosis is usually prefaced by "presumed' as the aetiology is not yet clear. The aim of this study was to evaluate the clinical features of a similar ocular syndrome in the Netherlands where the fungus Histoplasma capsulatum is not endemic.

Methods: A retrospective multicentre study in which all patients were included who were diagnosed with a syndrome similar to presumed ocular histoplasmosis and in whom both fluorescein angiogram and all complete patient data were available. Fluorescein angiograms were examined by three authors in a masked fashion. Eighty one patients were selected who fulfilled the ophthalmic criteria for presumed ocular histoplasmosis. Fifty one patients showed the classic clinical picture, while 30 patients had an incomplete form as they did not show numerous histospots.

Results: No major difference in clinical characteristics could be identified when comparing the group of patients with the classic syndrome with the one with the incomplete syndrome. Final visual outcome of patients with macular subretinal neovascularisation after laser treatment was better when compared with untreated patients (p < 0.01).

Conclusions: Since the fungus Histoplasma capsulatum is absent in the Netherlands, other aetiological agents must have led to this clinical entity similar to the presumed ocular histoplasmosis syndrome seen in the USA.

Figure 1

(A) Right eye, peripapillary atrophy, peripapillary histospots, mid peripheral atrophic chorioretinal scars. (B) Left eye with peripapillary atrophy and disciform macular lesion (same patient as (A)). (C) Left eye, peripheral linear streak.

Figure 2

Right eye of a patient who developed multifocal choroiditis.