A CASE REPORT AND LITERATURE REVIEW ON GRANULOMATOUS CONJUNCTIVITIS AND LYMPHOCUTANEOUS LESIONS ASSOCIATED WITH SPOROTRICHOSIS Sporotrichosis, a skin mycosis caused by Sporothrix sp., is a rarely reported condition in Malaysia. In this case report, we present a case of granulomatous conjunctivitis and lymphocutaneous lesions caused by sporotrichosis, along with a review of the relevant literature available on PUBMED. A 70-year-old woman presented with mucopurulent discharge from her left eye and nodular skin lesions on her face. She reported previous contact with her cat, which had recently died from sporotrichosis. Upon examination, the left eyelid was edematous, and there was conjunctival hyperemia. Multiple granulomatous lesions were observed in the bulbar conjunctiva, covered by the mucopurulent discharge. Additionally, erythematous and granulomatous nodules were present on the left periorbital area, extending to the left malar area, accompanied by ipsilateral lymphadenopathy. Based on clinical suspicion, a diagnosis of ocular and lymphocutaneous sporotrichosis was made. Treatment was initiated with oral itraconazole and topical fluconazole empirically. The conjunctival sample tested negative for Sporothrix schenckii. Histopathological examination of skin biopsy specimens revealed nonspecific granulomatous inflammation. After three months of antifungal treatment, the patient recovered completely without any ocular complications.

A 2-year-old girl who was under genetic follow up for developmental delay and dysmorphism was accidentally found to have bilateral optic disc swelling during screening examination. She showed response to optokinetic drum examination and the anterior segment examination was unremarkable. Optic disc swellings were seen in both eyes. Lumbar puncture shows high opening pressure of 50 cm H2O with unremarkable CSF analysis. MRI of brain was done and showed features in keeping with mild cerebral atrophy, with no evidence of hydrocephalus or space occupying lesion. She was diagnosed with idiopathic intracranial hypertension and oral acetazolamide 125mg bd was commenced. However, papilloedema persist despite medical therapy. Ventriculoperitonel shunt was inserted to reduce the csf pressure. This case report highlights the importance of considering idiopathic intracranial hypertension as a cause of optic disc swelling in pre-pubertal children because delay in diagnosis and treatment may permanently affect visual function especially in children.