A 51-year-old man, with no remarkable medical history besides being a chronic smoker, had been working his entire life as a farmer in a rural area of Colombia (Bajo Cauca-Antioquia) .He presented to the Infectious Diseases out-patient clinic with 6 months of progressive right eyelid edema, with purulent secretion but without any signs of periorbital cellulitis and a normal visual acuity, for which he had been treated with many different eye drops (steroid and antibiotic eye drops) without any significant clinical improvement.His only complaint was about subjective fevers and 5-Kg weight loss.Physical examination demonstrated that he was malnourished, with normal vital signs and had a severe right eye blepharitis (Figure 1A).The remainder of the exam did not show oral, chest, or abdominal findings.Then an eyelid biopsy was performed, showing multiple, narrow base, budding yeast cells (the "steering wheels") of Paracoccidioides brasiliensis on lactophenol blue staining (Figure 1B) .Culture on Saboreaud' s medium confirmed the mycological diagnosis.Treatment with oral itraconazole solution led to significant clinical improvement without any relapse on-m 6honth follow-up.Paracoccidioidomycosis (or South American blastomycosis) is a systemic mycosis of high prevalence in Latin America, caused by dimorphic fongus P. brasiliensis.It has different clinical forms and may affect any organ or system, but the ophthalmic involvement like the one seen in this case is rare, and when it occurs, it is usually secondary to primary ocular infection spreading by contiguity. 1 Isolated active lesions are usually diagnosticd as malignant tumors, and cicatricial changes are characterized by a high degree of fibrosis. 2If not treated, the mycosis can destroy the eyelid, but most of the cases can be treated with triazoles, being itraconazole considered the treatment of choice in mild-to-moderate cases, and amphotericin B is recommended only for severe cases. 3

A 51-year-old man, with no remarkable medical history besides being a chronic smoker, had been working his entire life as a farmer in a rural area of Colombia (Bajo Cauca-Antioquia).He presented to the Infectious Diseases out-patient clinic with 6 months of progressive right eyelid edema, with purulent secretion but without any signs of periorbital cellulitis and a normal visual acuity, for which he had been treated with many different eye drops (steroid and antibiotic eye drops) without any significant clinical improvement.His only complaint was about subjective fevers and 5-Kg weight loss.Physical examination demonstrated that he was malnourished, with normal vital signs and had a severe right eye blepharitis (Figure 1A).The remainder of the exam did not show oral, chest, or abdominal findings.Then an eyelid biopsy was performed, showing multiple, narrow base, budding yeast cells (the "steering wheels") of Paracoccidioides brasiliensis on lactophenol blue staining (Figure 1B).Culture on Saboreaud's medium confirmed the mycological diagnosis.Treatment with oral itraconazole solution led to significant clinical improvement without any relapse on 6-months follow-up.Paracoccidioidomycosis (or South American blastomycosis) is a systemic mycosis of high prevalence in Latin America, caused by dimorphic fungus P. brasiliensis.It has different clinical forms and may affect any organ or system, but the ophthalmic involvement like the one seen in this case is rare, and when it occurs, it is usually secondary to primary ocular infection spreading by contiguity. 1 Isolated active lesions are usually diagnosed as malignant tumors, and cicatricial changes are characterized by a high degree of fibrosis. 2If not treated, the mycosis can destroy the eyelid, but most of the cases can be treated with triazoles, being itraconazole considered the treatment of choice in mild-to-moderate cases, and amphotericin B is recommended only for severe cases. 3

A 51-year-old man, with no remarkable medical history besides being a chronic smoker, had been working his entire life as a farmer in a rural area of Colombia (Bajo Cauca-Antioquia). He presented to the Infectious Diseases out-patient clinic with 6 months of progressive right eyelid edema, with purulent secretion but without any signs of periorbital cellulitis and a normal visual acuity, for which he had been treated with many different eye drops (steroid and antibiotic eye drops) without any significant clinical His only complaint was about subjective fevers and 5 kg weight loss.Physical examination demonstrated that he was malnourished, with normal vital signs and had a severe right eye blepharitis (Figure 1A).The remainder of the exam did not show oral, chest, or abdominal findings.Then an eyelid biopsy was performed, showing multiple, narrow base, budding yeast cells (the "steering wheels") of Paracoccidioides brasiliensis on lactophenol blue staining (Figure 1B) .Culture on Saboreaud's medium confirmed the mycological diagnosis.Treatment with oral itraconazole solution led to significant improvement without any clinical relapse on 6-months follow-up.Paracoccidioidomycosis (or South American blastomycosis) is a systemic mycosis of high prevalence in Latin America, caused by dimorphic fungus P. brasiliensis.It has different clinical forms and may affect any organ or system, but the ophthalmic involvement like the one seen in this case is rare, and when it occurs, it is usually secondary to primary ocular infection spreading by contiguity. 1 Isolated active lesions are usually diagnosed as malignant tumors, and cicatricial changes are characterized by a high degree of fibrosis. 2If not treated, the mycosis can destroy the eyelid, but most of the cases can be treated with triazoles, itraconazole being considered the treatment of choice in mild-to-moderate cases, and amphotericin B is recommended only for severe cases. 3

رجل يبلغ من العمر 51 عامًا، ليس لديه تاريخ طبي ملحوظ إلى جانب كونه مدخنًا مزمنًا، كان يعمل طوال حياته كمزارع في منطقة ريفية في كولومبيا (Bajo Cauca - Antioquia). قدم إلى عيادة الأمراض المعدية الخارجية مع 6 أشهر من وذمة الجفن الأيمن التدريجي، مع إفراز قيحي ولكن دون أي علامات على التهاب النسيج الخلوي حول الحجاج وحدّة بصرية طبيعية، والتي عولج بها بالعديد من قطرات العين المختلفة (قطرات العين الستيرويدية والمضادات الحيوية) دون أي سريرية كبيرة كانت شكواه الوحيدة حول الحمى الذاتية وفقدان الوزن 5 كجم. أظهر الفحص البدني أنه يعاني من سوء التغذية، مع علامات حيوية طبيعية ولديه التهاب جفن شديد في العين اليمنى (الشكل 1 أ). لم تظهر بقية نتائج الفحص عن طريق الفم أو الصدر أو البطن. ثم تم إجراء خزعة للجفن، والتي أظهرت خلايا خميرة متعددة وضيقة (" عجلات القيادة ") من Paracoccidioides brasiliensis على تلطيخ اللاكتوفينول الأزرق (الشكل 1 ب). أكدت الثقافة على وسط سابوريو التشخيص الفطري. أدى العلاج بمحلول الإيتراكونازول الفموي إلى تحسن كبير دون أي انتكاسة سريرية في 6 أشهر follow.Paracoccidioidomycosis (أو الفطار البرعمي في أمريكا الجنوبية) هو فطار نظامي عالي الانتشار في أمريكا اللاتينية، ناجم عن الفطريات ثنائية الشكل P. brasiliensis. وله أشكال سريرية مختلفة وقد يؤثر على أي عضو أو نظام، ولكن المشاركة العينية مثل تلك التي شوهدت في هذه الحالة نادرة، وعندما تحدث، عادة ما تكون ثانوية لعدوى العين الأولية التي تنتشر عن طريق التجاور. 1 عادة ما يتم تشخيص الآفات النشطة المعزولة على أنها أورام خبيثة، وتتميز التغيرات الندبية بدرجة عالية من التليف. 2 إذا لم يتم علاجه، يمكن للفطار أن يدمر الجفن، ولكن معظم الحالات يمكن علاجها بالتريازول، ويعتبر الإيتراكونازول العلاج المفضل في الحالات الخفيفة إلى المتوسطة، ويوصى بالأمفوتيريسين ب فقط للحالات الشديدة. 3