Bilateral endogenous fungal endophthalmitis: A case report

Abstract

Rationale: Endogenous fungal endophthalmitis is a challenging condition. There are no universally accepted diagnostic or management protocols. We share a case of endogenous fungal endophthalmitis who was successfully treated, focusing on the diagnostic and treatment procedures. Patient concerns: A 31-year-old female with a history of fungal vaginitis and tinea corporis presented with progressive visual decrease in both eyes after having an induced abortion. Her best corrected visual acuity at presentation was 20/1000 in her right eye and 20/250 in her left eye. Upon slit lamp examination, mild inflammatory reaction in the anterior chamber was found. Dilated fundus examination revealed a hazy view of the optic disc and posterior retina, and there was a whitish mass with “string and pearls” just in front of the macular region in each eye. Diagnoses: Bilateral fungal endogenous endophthalmitis was diagnosed empirically, which was confirmed later by deoxyribonucleic acid sequencing and culture of intraocular fluid. Interventions: Oral itraconazole and intravitreal voriconazole were administered to the patient at first. The intraocular inflammation was partially responsive to the medication, yet the visual acuity persisted to deteriorate and the vitreous whitish masses became more prominent. Then vitrectomy procedures were carried out and oral itraconazle was switched to intravenous fluconazole. The antifungal treatment lasted for 8 weeks. Outcomes: The intraocular inflammation alleviated and visual acuity improved after vitrectomy. At the 9-month follow-up visit, the patient’s best corrected visual acuity was 20/40 in the right eye and 20/30 in the left eye. There was no intraocular inflammatary reaction, and retinal scar was noticed in each eye. Lesson: Early and correct diagnosis, coupled with prompt and aggressive treatment, is crucial for cases of fungal endogenous endophthalmitis. Deoxyribonucleic acid sequencing techniques can contribute to early diagnosis, while vitrectomy may be necessary when antifungal medication is insufficient in controlling the condition.

Literature- and Experience-Based Consensus for Acute Post-operative Endophthalmitis and Endogenous Endophthalmitis in Taiwan

“…Due to the hematogenous nature of EnE, anterior chamber reactions are sometimes mild when the posterior pole has fulminant presentations [ 70 , 71 ]. This characteristic is in contrast to that of acute post-operative endophthalmitis (Fig.…”

Fungal Endophthalmitis: Clinical Characteristics, Pathogens, and Factors Affecting Visual Outcome

“…Currently, there is no Level One evidence to guide FE management [ 1 ], and published data are limited in their spectrum of fungal species and disease management, particularly in China [ 13 , 14 , 15 ]. However, due to its overlapping clinical signs and symptoms with other endophthalmitis patterns and time-consuming etiological diagnosis, FE poses a challenge for its treatment [ 16 , 17 ].…”