Postoperative Endophthalmitis Caused by Candida Parapsilosis: A Case Report

Abstract

Purpose: To report an unusual case of postcataract endophthalmitis secondary to Candida parapsilosis. Case Presentation: A 77-year-old female patient was admitted to the emergency ward with reduced visual acuity (VA), and redness and pain in the right eye (RE) with a few hours of evolution. The patient underwent cataract surgery in the right eye 50 days earlier; no abnormalities were discovered in postsurgery check-ups on the following days. Biomicroscopy revealed corneal oedema, tyndall ++++, and flare +++. Capsule-shaped whitish deposits and posterior synechiae were also reported. Fundoscopy: not visible due to anterior segment opacity. RE ultrasound: mild vitritis, attached retina. Due to a strong suspicion of endophthalmitis, an aqueous humour biopsy was performed and the presence of Candida parapsilosis sensitive to amphotericin B and voriconazole was revealed. In view of a poor prognosis, we decided to carry out a vitrectomy, removal of the IOL + capsular bag complex and intravitreal injection of amphotericin B. After several check-ups, the patient reported being diagnosed with a fungal infection in her fingernails some time ago. She was referred for a microbiological testing, which confirmed the presence of Candida in the fingernails. Conclusions: Fungal endophthalmitis is uncommon in the postoperative setting, with most of the cases being attributable to the Candida species. The combination of pars plana vitrectomy, removal of the IOL + capsular bag complex and antifungal agents was able to successfully treat this case of postoperative endophthalmitis due to Candida parapsilosis. The relationship between postoperative Candida endophthalmitis and Candida nail infection is dramatic. To date, only one case of endogenous endophthalmitis associated with complicated onychomycosis has been reported.