Clinical and Multimodal Imaging Findings in Disseminated Mycobacterium Chimaera.

Abstract Purpose To characterize the ophthalmic clinical and multi-modal imaging findings of disseminated Mycobacterium chimaera infection after cardiothoracic surgery. Design Observational case series Subjects Four patients (eight eyes) with disseminated M. chimaera infection Methods Patients were evaluated with biomicroscopy, optical coherence tomography and angiography, fundus autofluorescence, fluorescein and indocyanine green angiography. Main Outcome Measures Clinical and multimodal imaging findings of patients with disseminated M. chimaera Results All four patients were Caucasian men with a mean age of 65.5 years (60 to 75 years) who had aortic valve and/or root infection with M. chimaera diagnosed by culture and/or gene sequencing All four patients had bilateral choroidal lesions on fundoscopy and evidence of osteomyelitis by imaging and/or culture at the time of ocular diagnosis. Indocyanine green and optical coherence tomography angiography revealed numerous additional subclinical choroidal lesions and were used to track disease response to therapy. Fluorescein angiography and fundus autofluorescence were useful in determining lesion age and activity. All patients were treated with three or four drug anti-mycobacterial therapy. Three underwent revision of their cardiothoracic surgery with removal of infected graft. One patient went on to developed progressive ocular disease which was noted before each of his surgical revisions. Two patients had improvement in ocular and systemic disease but one of them developed a choroidal neovascular membrane. The final patient was a single encounter but had clinical and imaging findings of longstanding inactive disease. Conclusions Ophthalmologists should be aware of the systemic and ocular findings of this rare life-threatening disease. Multimodal imaging is useful in corroborating a diagnosis of ocular M. Chimaera and particularly in evaluating patient response to therapy as choroidal activity appears to mimic systemic activity. Treating physicians should be aware of the co-occurrence of choroiditis and osteomyelitis. Choroidal neovascular membrane can also be a late complication of this disease