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Clinical history
Immunocompromised middle-aged patient
Diagnosis
Monocytic acute myeloid leukemia (AML) and fungal endophthalmitis. This middle-aged patient had a 1-year history of monocytic acute myeloid leukemia with a mutant FLT3 gene (FLT3-ITD; ITD = internal tandem duplication). Headache and fevers led to the diagnosis of a fungal infection of the brain. Widespread infection despite anti-fungal therapy led to the death of the patient. At autopsy, the eye had the following major abnormalities: 1) leukemic infiltration predominantly of the choroid with some choroidal vessels packed with tumor cells. 2) fungal forms in the retina, sclera, choroid, and vitreous, with the vitreous forms most apparent on this H & E slide. The fungus was Lomentospora prolificans (aka scedosporium prolificans).
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