Endogenous fungal endophthalmitis following intensive corticosteroid therapy in severe COVID-19 disease

Abstract

Purpose: To report endogenous fungal endophthalmitis, postrecovery from severe COVID-19 infection in otherwise immunocompetent individuals, treated with prolonged systemic steroids. Methods: Retrospective chart review of cases with confirmed and presumed fungal endogenous endophthalmitis, following severe COVID-19 disease, treated at two tertiary care referral eye institutes in North India. Results: Seven eyes of five cases of endogenous fungal endophthalmitis were studied. All cases had been hospitalized for severe COVID-19 pneumonia and had received systemic steroid therapy for an average duration of 42 ± 25.1 days (range 18–80 days). All the cases initially complained of floaters with blurred vision after an average of 6 days (range 1–14 days) following discharge from hospital. They had all been misdiagnosed as noninfectious uveitis by their primary ophthalmologists. All eyes underwent pars plana vitrectomy (PPV) with intravitreal antifungal therapy. Five of the seven eyes grew fungus as the causative organism (Candida sp. in four eyes, Aspergillus sp. in one eye). Postoperatively, all eyes showed control of the infection with a marked reduction in vitreous exudates and improvement in vision. Conclusion: Floaters and blurred vision developed in patients after they recovered from severe COVID-19 infection. They had received prolonged corticosteroid treatment for COVID-19 as well as for suspected noninfectious uveitis. We diagnosed and treated them for endogenous fungal endophthalmitis. All eyes showed anatomical and functional improvement after PPV with antifungal therapy. It is important for ophthalmologists and physicians to be aware of this as prompt treatment could control the infection and salvage vision.

Commentary: A case of endogenous candida endophthalmitis with incidental cytomegalovirus infection and optic neuropathy in a patient recovered from severe COVID-19

“…[ 6 ] Posterior segment involvement has been seen as central retinal vein occlusion,[ 7 ] and endogenous fungal endophthalmitis following severe COVID-19 disease has been noted. [ 8 ]…”

Endogenous fungal endopthalmitis treated with intravitreal caspofungin in a COVID-19 recovered patient: A case report

“…[ 1 ] Posterior segment involvement seen as central retinal vein occlusion[ 2 ] and endogenous fungal endophthalmitis following severe COVID-19 disease have also been reported. [ 3 ] We discuss endogenous fungal endophthalmitis in a recovered COVID-19 patient.…”

A case of endogenous candida endophthalmitis with incidental cytomegalovirus infection and optic neuropathy in a patient recovered from severe COVID-19

“…Prolonged use of high-dose steroids in the management of COVID-19 pneumonia enhances opportunistic infections in clinically susceptible immunocompromised patients. [ 1 ] Therefore, in post-COVID-19-pneumonia patients presenting with blurred vision, floaters and painful red eyes, high level of clinical suspicion of endogenous endophthalmitis would preserve vision and other life-threatening complications due to hematogenous spread of opportunistic infections. We report the approach and management of a case of Candida Endophthalmitis complicated with incidental CMV infection of vitreous fluid (mixed infection) and optic neuropathy in a patient who recovered from severe SARS COVID-19 pneumonia.…”