Abstract
BackgroundEndogenous fungal endophthalmitis is a serious vision-threatening condition that occurs in immunosuppressed patients with candidemia.FindingsWe report a complicated case of Candida albicans chorioretinitis that progressed to endophthalmitis. The patient required intravitreal and systemic anti-fungal medications with pars plana vitrectomy for successful treatment. Multimodal imaging using fundus photography, fluorescein angiography, spectral domain optical coherence tomography, and fundus autofluorescence was obtained throughout treatment. These modalities localized the Candida infection in the choroid, penetrating Bruch’s membrane, the retinal pigment epithelium, and the retina to enter the vitreous cavity. This infectious route resulted in loss of the retinal pigment epithelium, photoreceptors, and outer retinal layers, with scar formation that resulted in vision loss and increased future risk of choroidal neovascular membranes.ConclusionsMultimodal imaging of C. albicans chorioretinitis allows for accurate diagnosis, assessment of response to therapy, and prognosis for visual recovery and future complications.
Highlights
Endogenous fungal endophthalmitis is a serious vision-threatening condition that occurs in immunosuppressed patients with candidemia
In 14 % of patients with Candidemia, ocular complications occur [2]. The majority of these patients develop chorioretinitis with 1.6 % of patients advancing to endophthalmitis [2]
In patients with yeast endophthalmitis, visual acuity outcomes can be poor with only 56 % of eyes achieving vision of 20/200 or better [1]
Summary
Endogenous fungal endophthalmitis is a serious vision-threatening condition that occurs in immunosuppressed patients with candidemia. This case report describes the clinical course of a patient with C. albicans chorioretinitis that progressed to recalcitrant endophthalmitis. Visual acuity remained 20/100 OD, the anterior segment was unchanged, and the posterior segment displayed vitritis with a fluffy chorioretinal lesion (Fig. 1d). The patient received a same-day intravitreal injection of amphotericin B (5 μg/0.1 mL) and was placed on intravenous amphotericin B (0.1 mg/mL).
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