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MULTIMODAL IMAGING OF CHOROIDAL LESIONS IN DISSEMINATED MYCOBACTERIUM CHIMAERA INFECTION AFTER CARDIOTHORACIC SURGERY

Böni, Christian, MD*; Al-Sheikh, Mayss, MD*; Hasse, Barbara, MD; Eberhard, Roman, MD*; Kohler, Philipp, MD, MSc†,‡; Hasler, Pascal, MD§; Erb, Stefan, MD; Hoffmann, Matthias, MD; Barthelmes, Daniel, MD, PhD*,**; Zweifel, Sandrine, A., MD*

doi: 10.1097/IAE.0000000000001991
Original Study: PDF Only

Purpose: To explore morphologic characteristics of choroidal lesions in patients with disseminated Mycobacterium chimaera infection subsequent to open-heart surgery.

Methods: Nine patients (18 eyes) with systemic M. chimaera infection were reviewed. Activity of choroidal lesions were evaluated using biomicroscopy, fundus autofluorescence, enhanced depth imaging optical coherence tomography, fluorescein angiography/indocyanine green angiography, and optical coherence tomography angiography. Relationships of choroidal findings to systemic disease activity were sought.

Results: All 9 male patients, aged between 49 and 66 years, were diagnosed with endocarditis and/or aortic graft infection. Mean follow-up was 17.6 months. Four patients had only inactive lesions (mild disease). In all five patients (10 eyes) with progressive ocular disease, indocyanine green angiography was superior to other tests for revealing new lesions and active lesions correlated with hyporeflective choroidal areas on enhanced depth imaging optical coherence tomography. One eye with a large choroidal granuloma developed choroidal neovascularization. Optical coherence tomography angiography showed areas with reduced perfusion at the inner choroid. All 5 patients with progressive ocular disease had evidence of systemic disease activity within ±6 weeks' duration.

Conclusion: Choroidal manifestation of disseminated M. chimaera infection indicates systemic disease activity. Multimodal imaging is suitable to recognize progressive ocular disease. We propose ophthalmologic screening examinations for patients with M. chimaera infection.

In patients with bilateral multifocal choroiditis and a history of cardiothoracic surgery, disseminated Mycobacterium chimaera infection should be suspected. Differentiating between active and inactive ocular disease is important because of the correlation with systemic disease activity. Monitoring patients at risk is recommended by clinical examination and multimodal imaging.

*Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland;

Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland;

Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland;

§Department of Ophthalmology, University Hospital Basel, University Basel, Basel, Switzerland;

Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Basel, Switzerland; and

**Save Sight Institute, The University of Sydney, Sydney, Australia.

Reprint requests: Christian Böni, MD, Frauenklinikstrasse 24, 8091 Zurich, Switzerland; e-mail: christian.boeni@usz.ch

None of the authors has any financial/conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.