Bilateral infectious scleritis from Histoplasma capsulatum in an immunosuppressed uveitis patient

PURPOSE: To describe a case of bilateral infectious scleritis secondary to Histoplasma capsulatum in the setting of a locally and systemically immunosuppressed patient. OBSERVATIONS: A 45-year-old man with HLA-B27 associated ankylosing spondylitis and anterior uveitis on systemic secokinumab, underwent bilateral cataract extraction which required extensive peri-operative steroids, including intravitreal triamcinolone, topical prednisolone, and oral prednisone. Six weeks after cataract surgery, the patient presented with mild eye irritation and was found to have bilateral subconjunctival purulence and necrosis. Histoplasma capsulatum was identified on fungal cultures and confirmed by DNA probe. The patient was treated with fortified amphotericin drops and oral itraconazole with complete resolution of scleritis. CONCLUSION AND IMPORTANCE: H. capsulatum is a rare cause of infectious scleritis that must be considered in our immunosuppressed and post-surgical patients.