Acute Fusarium solani endophthalmitis secondary to keratitis following cataract surgery

Abstract

We report a case of fungal endophthalmitis in a 73-year-old woman secondary to Fusarium keratitis, which developed 1 week after complicated cataract surgery. The culture of corneal scraping specimens revealed isolated methicillin-resistant coagulase-negative staphylococci, whereas vitreous culture results identified Fusarium solani, which had a high minimum inhibitory concentration (MIC) (MIC >32 mg/mL) to amphotericin B, itraconazole, posaconazole, and a relatively low MIC concentration (MIC R4 mg/mL) to voriconazole. The primary source of infection (keratitis) and the associated endophthalmitis was controlled after several intravitreal and corneal intrastromal voriconazole injections, but the cornea perforated in the melting area. Although fungal keratitis after cataract surgery is rare, it may mimic a bacterial infection and the eventual failure of the initial empirical therapy might result in endophthalmitis. It is important, therefore, to obtain specimens for both fungal and bacterial cultures in atypical cases.