Multiple and simultaneous manifestation of ocular inflammation in neurological disease

We report a rare manifestation of herpetic viral retinitis and encephalitis in a patient with reactivation of pulmonary aspergillosis eventually progressing to involve the eye causing choroidal infiltration. Ocular features can have widespread involvement and can affect vision. An 89-year-old male patient presented with fever, defective vision, difficulty in walking with involuntary movements in the right side of his body and history of treatment for pulmonary aspergillosis. Computed tomography Scanogram showed a bronchiectatic cavity with extensive fibrosis, few parenchymal calcific specks and adjacent pleural thickening. Ophthalmic examination showed pseudophakia in both eyes with nasal pterygium in the right eye. Fundus evaluation in both eyes showed pale optic disc, circumferential retinal infiltrates at the posterior pole and periphery, vitritis and patchy sheathing along arteries. A provisional diagnosis of herpetic retinitis was made and he was advised to continue intravenous acyclovir. On review after 24 hours, fundus showed creamy choroidal patches suggestive of aspergillus endophthalmitis and a combined aetiology for the retinitis was considered. On the third review the vitritis appeared to be settling with better definition of retinitis but his systemic status continued to deteriorate. A clinical suspicion and holistic approach in such patients will improve both ocular and systemic status.