Bilateral fungal endophthalmitis masquerading as multifocal chorioretinitis.

Abstract

Spontaneous healing of ocular Candida infection is extremely rare, and early clinical manifestations may be misleading. This report explicates how to make the appropriate diagnosis when facing atypical presentation of the disease. Case report. A 36-year-old woman presented with bilateral chorioretinitis. Intravenous drug abuse was not suspected, and a diagnosis of multifocal chorioretinitis was made. Oral corticosteroid treatment was started. Three months later, all previously seen lesions had healed on the right eye but had increased on the left with development of severe endophthalmitis. Microbiologic analysis of scalp pustules yielded Candida albicans. She underwent vitrectomy, intravitreous amphotericin B injection, and systemic fluconazole treatment. The uveitis responded well to this treatment regiment, but subsequent development of macular edema and retinal detachment in the left eye limited the final visual acuity to 20/200. Visual acuity remained 20/20 on the right without any evidence of inflammation. This case demonstrates a broad range of potential outcomes after Candida endophthalmitis in the same patient, from very rare healing without antifungal treatment in one eye to severe panuveitis in the other eye. The delayed diagnosis in this case led to the inappropriate treatment with corticosteroids alone and delayed antifungal treatment. Early differentiation of Candida chorioretinitis from multifocal chorioretinitis is critical to final visual outcome.