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Dacryoadenitis Caused by Blastomycosis

A Case Report

Kwan, Changyow C. B.S.; Prager, Alisa J. M.D.; Huang, Russell M. M.D.; Bryar, Paul J. M.D.; Thyparampil, Preeti J. M.D.

Ophthalmic Plastic & Reconstructive Surgery: September/October 2019 - Volume 35 - Issue 5 - p e116–e118
doi: 10.1097/IOP.0000000000001445
Case Reports

This is the first case of histopathologically proven blastomycosis involving the lacrimal gland. A 51-year-old woman with a history of disseminated blastomycosis involving her lungs and skin, on oral itraconazole, presented with 3 days of right upper eyelid swelling, erythema, and pain concerning for recurrent dacryoadenitis. MRI showed enlargement of the right lacrimal gland with a cystic lesion at the anterior aspect of the gland with a radiographic differential diagnosis of abscess versus cyst. After no improvement with intravenous antibiotics, orbitotomy with lacrimal gland biopsy and incision and drainage of the cystic lesion were performed. Culture and pathology of the drained fluid demonstrated an abscess with both viable and nonviable broad-based budding yeast consistent with partially treated blastomycosis. The patient’s symptoms improved after the surgery and continued itraconazole therapy.

This is a rare case of biopsy-proven dacryoadenitis caused by blastomycosis in a 51-year-old female.

Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A.

Accepted for publication June 27, 2019.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Preeti J. Thyparampil, M.D., Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 645 N. Michigan Avenue, Ste. 440, Chicago, IL 60611.

© 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.