Conjunctival Aspergilloma with Multiple Mulberry Nodules: A Case Report

本病例報告一位三十歲身體健康女性，主訴左眼有分泌物，溢淚，與異物感長達一年。眼部檢查發現左上眼瞼結膜有明顯乳突炎性反應，且有一結膜下結節。經手術切除結節之後給予局部藥物治療。此結節病理報告顯示內含數個黑色桑椹狀小節瘤，在顯微鏡高倍率放大且經過染色下，可以見到具有分節的菌絲，符合麴菌的診斷。雖然麴菌可以是結膜上的正常菌落，在很少的機會下也可能侵入到結膜下。此一病例報告呈現出麴菌也可以在免疫健全的情況下，造成一長期結膜發炎的表現。
A 30-year-old healthy female presented with a 1-year history of chronic mucous discharge, tearing, and irritation in the left eye. Slit-lamp examination revealed severe papillary and follicular reaction surrounding a movable subconjunctival mass on the left upper tarsal conjunctiva. Incision and curettage were performed to establish the diagnosis. Multiple peculiar black mulberry nodules were obtained. The clumps of septate hyphae seen with periodic acid-Schiff stain were characteristic of fungus ball (aspergilloma). The patient’s symptoms improved significantly after surgery without any antifungal therapy. Although rarely reported, aspergillus is a common fungus in the conjunctiva that may seed into the subconjunctiva. We present this case to remind ophthalmologists of such a rare cause of recalcitrant conjunctival inflammation in immunocompetent patients.