DOI: 10.36347/sjmcr.2024.v12i05.083

Pages: 894-898

Presumed Ocular Histoplasmosis Syndrome (PHOS) is a clinical condition characterized by chronic inflammation of the choroid and retina, often accompanied by the growth of abnormal blood vessels in the macula known as choroidal neovascularization (CNV). While PHOS is typically seen in regions where Histoplasma capsulatum is endemic, there have been reported cases in non-endemic areas. This case report presents the details of a 32-year-old Moroccan patient with PHOS and macular CNV, highlighting the diagnostic, therapeutic, and practical considerations involved in their treatment. The patient, who had no significant medical history, came to us with a six-month history of central vision loss, intermittent metamorphopsia, and central scotomas in the left eye. Despite having no exposure to environmental risk factors or travel to areas where histoplasmosis is prevalent, our clinical examination revealed choroidal and retinal lesions consistent with histospots and active CNV. Further tests such as fluorescein angiography and optical coherence tomography (OCT) confirmed the presence of CNV, revealing a subretinal fibrovascular membrane and serohemorrhagic detachment. Based on these findings, we diagnosed the patient with PHOS and CNV. We proceeded with treatment using intravitreal ranibizumab, a monoclonal antibody that targets vascular endothelial growth factor (VEGF). Monthly injections resulted in the stabilization of the patient's condition, both clinically and anatomically. The CNV regressed, the serohemorrhagic detachment resolved, and there was a significant improvement in the patient's visual acuity. The discussion in this report highlights the fact that while PHOS is typically associated with Histoplasma capsulatum infection, the occurrence of cases in non-endemic areas raises questions about its etiology and diagnosis. In this particular instance, the patient's exposure to the fungus or potential infection by other fungal species complicates the process ..........