Aspergillus endophthalmitis. An unrecognized endemic disease in orthotopic liver transplantation.

PURPOSE: The authors discovered an unusually high incidence of Aspergillus endophthalmitis in an autopsy series of orthotopic liver transplantation recipients. This study was conducted to discern the frequency, topographic distribution, and potential significance of the infections.

METHODS: Autopsy reports from liver transplant patients were reviewed. All patients with Aspergillus endophthalmitis were studied by gross and histologic examination. Histologic sections were stained with Grocott-Gomori methenamine-silver nitrate and periodic acid-Schiff stains. Some Grocott-Gomori methenamine-silver nitrate stained sections were counterstained with hematoxylin-eosin. The distribution of ocular infections in the eye was determined for each patient. The organs infected were determined at autopsy.

RESULTS: The authors found seven patients with Aspergillus endophthalmitis. Six of these seven patients were from a group of 85 (7.1%) orthotopic liver transplantation recipients. Fourteen (16.5%) orthotopic liver transplantation recipients had invasive pulmonary aspergillosis and ten (11.8%) had disseminated disease. The eyes were the second most common site of infection. Two patients had ocular involvement as the only nonpulmonary site of infection. Aspergillus endophthalmitis was diagnosed in only one patient before death. Infection was located posterior to the equator in all patients; three patients were anterior to the equator as well. The retina (5/7), vitreous (5/7), and choroid (3/7) were common sites of infection.

CONCLUSIONS: This is the first report of Aspergillus endophthalmitis associated with orthotopic liver transplantation recipients. Patients with orthotopic liver transplants are unusually susceptible to invasive aspergillosis and Aspergillus endophthalmitis. Aspergillus infection is frequently bilateral, begins posteriorly in the retina or choroid, and has vitreous involvement. Recognition of this entity is important because many patients die of disseminated Aspergillus infection that may be detected early with bedside funduscopic examination.