Systemic Voriconazole Research Articles

Fungal bezoar of bladder in type 2 diabetic mellitus patient: A case report

A 54 year male, post operated case of bypass surgery presented to a Urologist with acute retention of urine. Patient was relieved by catheterization and bladder irrigation. WBC’s and RBC’s were increased in Urine. Cystoscopy revealed fungal balls in the bladder which on histopathological examination showed aseptate hyphae and spores. Patient was managed by systemic voriconazole and diluted povidone iodine bladder wash. Predisposing factors were diabetes mellitus and dyslipidemia. This case stresses the importance of considering isolated fungal urinary infections in predisposed individuals.

Limbal Subconjunctival Abscess: A Rare Complication of Acanthamoeba Keratitis.

Acanthamoeba keratitis (AK) is a rare infection affecting the cornea. Immune-mediated sclerokeratitis is a well-documented late complication often requiring systemic immunosuppression. We present an alternative clinical presentation of subconjunctival abscesses caused by direct invasion of the Acanthamoeba and a proposed management strategy. This study was a single case report performed at a tertiary care center in the United Kingdom. A 42-year-old contact lens wearer with a history of swimming in contact lenses presented with 2 days of pain, redness, and photophobia. There was clinical suspicion for AK that was later confirmed on confocal microscopy and cultures. Four months into treatment with polyhexamethylene biguanide 0.06% monotherapy, they experienced a relapse of symptoms and developed multiple subconjunctival limbal abscesses with associated scleritis. These were drained in the office, and topical treatment changed to chlorhexidine 0.2%. The aspirate was culture-positive Acanthamoeba. Despite initially improving, the abscess reoccurred within a month. Repeat drainage was performed, and topical and oral voriconazole was added to the treatment regime. The abscess resolved leaving an area of scleromalacia. Despite immune-mediated sclerokeratitis being a more common complication of AK, infectious scleritis can also occur. Correct identification of the cause of scleritis is required to prevent mistreatment of infectious scleritis with systemic immunosuppression. The abscess resolved with repeated drainage and the use of topical and systemic voriconazole.

Idiopathic Fusarium Sclerouveitis: A Case Report.

To report a successfully managed case of idiopathic Fusarium sclerouveitis in a healthy patient with no identifiable risk factors. We describe a case of a 79-year-old man who presented with right-sided eye, facial, and head pain. Initial examination revealed temporal scleral thinning, inflammation, and anterior chamber cell/flare. Cultures were positive for Fusarium species. The patient was treated with sub-Tenon amphotericin, intrascleral voriconazole, surgical debridement, Rose Bengal photodynamic therapy, systemic voriconazole and posaconazole, and topical natamycin. The infection resolved and the patient's visual acuity improved to 20/40. Fusarium sclerouveitis can occur without clear risk factors. This case highlights the importance of an aggressive, multimodal treatment approach for successful management.

A case of Lomentospora prolificans endophthalmitis treated with the novel antifungal agent Olorofim

PurposeTo report a case of endogenous Lomentospora prolificans endophthalmitis treated with the novel antifungal agent Olorofim.Case reportA 57-year-old man developed disseminated Lomentospora prolificans with right endophthalmitis on the background of immunosuppression following lung transplantation for interstitial lung disease. He was treated with early vitrectomy, intravitreal voriconazole, and systemic Olorofim, voriconazole and terbinafine. His symptoms improved and remained stable in the right eye. Eight weeks later the patient represented with Lomentopora prolificans endophthalmitis in the left eye when systemic voriconazole and terbinafine treatment were withdrawn. Despite aggressive treatment he ultimately succumbed due to vascular complications of extensive disseminated disease.ConclusionWe report a rare case of disseminated Lomentosporosis with panophthalmitis in an immunocompromised host with prolonged survival on systemic Olorofim, voriconazole and terbinafine in conjunction with pars plana vitrectomy and intravitreal voriconazole. Early suspicion of an opportunistic fungal infection is critical, as managing disseminated disease is often unsuccessful. Despite presumed inherent resistance, intravitreal and systemic voriconazole appeared to limit disease progression in the right eye. The potential synergistic effects of combined antifungal therapy with orotomides warrant further investigation.

Endogenous Fungal Endophthalmitis: A Single-Center Retrospective Study and Review of the Literature

To evaluate factors that inform systemic antifungal choices in patients with endogenous fungal endophthalmitis (EFE). Single-institution retrospective case series. Charts of EFE patients from 2010 to 2023 were reviewed. Patients treated systemically for EFE with a minimum of 14 days of follow-up were included. Outcome measures included time to improvement in vitritis or chorioretinitis, systemic therapy modification, and need for surgical intervention. A total of 20 eyes of 16 patients were included. Candida species were most common (43.8%), followed by culture-negative EFE (37.5%) and Aspergillus species (18.8%). In all, 90% of eyes had vitritis and/or macula-involving chorioretinitis. The majority of Candida infections (60%) or culture-negative EFE (75%) were treated initially with oral antifungals. Patients with a history of immune compromise, positive fungal culture, or positive Fungitell assay were more likely to be treated with early intravenous (IV) antifungal therapy. Two patients required systemic antifungal therapy modification because of worsening chorioretinitis, in 1 case due to voriconazole-resistant Aspergillosis that demonstrated chorioretinal lesion growth despite intravitreal amphotericin B injections and systemic voriconazole, and in the second case due to worsening chorioretinitis from Candida dubliniensis infection that regressed upon switch from oral to IV fluconazole. Initial systemic treatment decisions in patients with EFE were driven by systemic culture positivity, systemic symptoms, or comorbidities. Intravitreal antifungal therapy may be insufficient to arrest progression of chorioretinal lesions in some cases. Larger studies are needed to determine whether visible end-organ damage in the form of chorioretinitis may be useful for guiding systemic therapy changes.

Instillation of Amphotericin B by bronchoscopy combined with systemic voriconazole in advanced non-small cell lung cancer patients with chronic cavitary pulmonary aspergillosis: A case series and literature review.

Although the treatment of aspergillosis has been studied for years, the optimal nonsurgical treatment of chronic cavitary pulmonary aspergillosis (CCPA) remains unsatisfactory, especially in lung cancer. We report two advanced non-small cell lung cancer (NSCLC) patients who recovered from CCPA following instillation of Amphotericin B (AmB) by bronchoscopy combined with systemic voriconazole. The first patient was diagnosed with lung adenocarcinoma after right upper lobe resection and was treated with anaplastic lymphoma kinase-targeted therapy. Chest computed tomography (CT) revealed a right pulmonary cavity containing solid materials. The second patient was diagnosed with squamous cell carcinoma and received immunotherapy following surgery, chemotherapy, and radiotherapy. Chest CT tomography revealed a mass in the right lung cavity. Both patients' cultures and next-generation sequencing of their bronchoalveolar lavage (BAL) samples revealed presence of Aspergillus fumigatus. In addition, the galactomannan test of both patients BAL samples was positive. Systemic voriconazole was prescribed based on in vitro susceptibility testing. The chest images and clinical symptoms of both patients did not improve after one month of voriconazole therapy within the therapeutic blood concentration. Considering the low local concentrations of antifungals against CCPA, AmB instillation by bronchoscopy combined with systemic voriconazole was utilized. The chest CT images and clinical symptoms of both patients markedly improved in the following third month. Instillation of AmB combined with systemic voriconazole may be a promising treatment option for NSCLC patients with CCPA who fail voriconazole monotherapy.

Postoperative Aspergillus Infection: A Case Series

ABSTRACT Purpose To report the clinical findings, therapy and outcomes of pauci-symptomatic Aspergillus infection in 11 eyes of 11 patients who had recently undergone uneventful cataract surgery and IOL implantation in a single operating room on the same day. Methods Retrospective, observational study that looks at 11 patients who demonstrated Aspergillus infection after cataract surgery. All data were collected and intracameral samples sent for microscopic evaluation and culture. Additional swabs were sent from the operating room and operative consumables. Results A total of 11 eyes of 11 patients were included in the analysis and were followed for at least 12 months. All patients responded completely to local and systemic voriconazole therapy. The source of infection was noted to be air-conditioning vents. Eyes with manual small incision cataract surgery (11/17) had a higher propensity for infection. Conclusion Pauci-symptomatic aspergillosis infection has been reported here following cataract surgery.

Successful Adjunctive Treatment of a Severe Case of COVID-19 Associated Pulmonary Aspergillosis with Nebulized Liposomal Amphotericin B

We report a case of a patient suffering from severe COVID-19 complicated by CAPA (COVID-19 associated pulmonary aspergillosis). Successful therapy with systemic voriconazole and isavuconazole failed, liposomal Amphotericin B was not possible due to acute renal failure. After nebulized Amphotericin was added to systemic isavuconazole, CAPA could be treated successfully.

Scedosporium scleritis following pterygium excision with conjunctival autograft

A 67-year-old female presented 6 months following left pterygium surgery with autoconjunctival graft with presumed episcleritis. Following a trial of topical dexamethasone, she returned with pain, reduced vision, and a donor-site scleral nodule. MRI orbits demonstrated scleritis; oral prednisolone was commenced for presumed immune-mediated scleritis. Ten days later, vision reduced to light-perception with significant vitritis overlying a subretinal lesion associated with the donor site. Vitreous tap cultured Scedosporium aurantiacum. Treatment consisted of vitrectomy, scleral debridement with corneal patch graft, with both systemic and intravitreal voriconazole. Further scleral debridement was attempted but unable to be completed due to its posterior extent. As repeat MRI orbits showed persistent active scleritis in proximity to the optic nerve which posed a risk of meningitis, a decision was made for enucleation. This case highlights the difficulties in distinguishing between infectious and autoimmune scleritis, and the importance of excluding infection, particularly in eyes with prior surgery.

Antifungal Prophylaxis After Lung Transplantation: Where Are We Now?

Lung transplantation is an important treatment option for various end-stage lung diseases. However, survival remains limited due to graft rejection and infections. Despite that fungal infections are frequent and carry a bad prognosis, there is currently no consensus on efficacy, optimal drug, route, or duration of antifungal prophylaxis. This narrative review summarizes current strategies for antifungal prophylaxis after lung transplantation. English language articles in Embase, Pubmed, UptoDate, and bibliographies were used to assess the efficacy and safety of available antifungal agents for prophylaxis in adult lung transplant recipients. Overall, there are limited high-quality data. Universal prophylaxis is more widely used and may be preferable over targeted prophylaxis. Both formulations of inhaled amphotericin B and systemic azoles are effective at reducing fungal infection rates, yet with their own specific advantages and disadvantages. The benefit of combination regimens has yet to be proven. Considering the post-transplant timing of the onset of fungal infections, postoperative prophylaxis during the first postoperative months seems indicated for most patients. Based on existing literature, universal antifungal prophylaxis with inhaled amphotericin B and systemic voriconazole for at least 3-6 mo after lung transplantation may be advisable, with a slight preference for amphotericin B because of its better safety profile.

A Case of Fusarium Keratitis Developing after Contact with Animal Faeces

Fungal agents come second after bacteria in the etiology of keratitis. Fusarium species also have an important place among keratitis agents. Among the factors that predispose to fungal keratitis, traumas constitute the most important place. Traumas occurring especially with organic materials are among the most common causes in the development of fungal keratitis. Fusarium species are difficult to treat due to the high antifungal resistance rate. In our study, a case of Fusarium-induced keratitis, which started after contact with animal feces and progressed to endophthalmitis during the follow-up, was presented in a woman who does not have a known disease and is engaged in agriculture. The patient was treated with topical and systemic voriconazole therapy and co-administration of keratoplasty operation.

A diagnostic challenge of invasive sellar neuroaspergillosis in an immunocompetent patient

The commonest differential for sellar space occupying lesion is tumor, and clinicians would rarely consider aspergillosis at this location in an immunocompetent patient. Hence, a high index of suspicion clinically and histological confirmation are required to reach the diagnosis. Here, we report a case of such, a 28-year-old immunocompetent male presented with headache, vomiting, and diplopia for 7 days without any history of convulsion, unconsciousness or nasal symptoms. His magnetic resonance imaging and computed tomography of the brain and pituitary gland were suggestive of a primary bone tumor or pituitary macroadenoma of the sellar region. He then underwent surgery, and intraoperative squash cytology, frozen section, and fine-needle aspiration cytology of aspirated pus revealed necrotizing granulomatous lesion of fungal etiology. Postoperative histopathology and special stains (periodic acid-Schiff, Gomori methenamine silver) confirmed invasive aspergillosis, and Aspergillus flavus was isolated by pus culture. The surgery was followed by systemic voriconazole therapy, and there were no further complications.

Utility of systemic voriconazole in equine keratomycosis based on pharmacokinetic-pharmacodynamic analysis of tear fluid following oral administration.

ObjectiveTo clarify the detailed pharmacokinetics (PK) of orally administered voriconazole in tear fluid (TF) of horses for evaluating the efficacy of voriconazole secreted into TF against equine keratomycosis.Animals studiedFive healthy Thoroughbred horses.ProceduresVoriconazole was administrated through a nasogastric tube to each horse at a single dose of 4.0 mg/kg. TF and blood samples were collected before and periodically throughout the 24 hours after administration. Voriconazole concentrations in plasma and TF samples were analyzed using liquid chromatography‐electrospray tandem‐mass spectrometry. The predicted voriconazole concentration in both samples following multiple dosing every 24 hours was simulated by the superposition principle.ResultsThe mean maximum voriconazole concentrations in plasma and TF were 3.3 μg/mL at 1.5 h and 1.9 μg/mL at 1.6 h, respectively. Mean half‐life in both samples were 16.4 and 25.2 h, respectively. The ratio of predicted AUC0–24 at steady state in TF (51.3 μg∙h/mL) to previously published minimum inhibitory concentration (MIC) of Aspergillus and Fusarium species was >100 and 25.7, respectively.ConclusionsThis study demonstrated the detailed single‐dose PK of voriconazole in TF after oral administration and simulated the predicted concentration curves in a multiple oral dosing. Based on the analyses of PK‐PD, the simulation results indicated that repeated oral administration of voriconazole at 4.0 mg/kg/d achieves the ratio of AUC to MIC associated with treatment efficacy against Aspergillus species. The detailed PK‐PD analyses against pathogenic fungi in TF can be used to provide evidence‐based medicine for equine keratomycosis.

2112. Voriconazole for Primary Prophylaxis: A Decade of Trends and Outcomes

BackgroundInvasive fungal infections (IFI) continue to affect the immunocompromised patient population. Many of these patients require antifungal prophylaxis. Voriconazole is an azole antifungal that has been utilized for preventing IFIs but does not have an approved indication for prophylaxis.MethodsAdult patients admitted to Duke University Hospital from January 1, 2005 to December 31, 2015 who had received at least 2 days of systemic voriconazole as primary prophylaxis were included in this retrospective medical records review. Demographics, underlying comorbidities, adverse events, drug interactions, voriconazole blood concentrations, and microbiological data were assessed.ResultsOur review identified 403 patients receiving voriconazole for primary prophylaxis. 220 (55.6%) were male, 303 (75.2%) were Caucasian, and the mean age was 46.0 ± 15.7 years. 233 (57.8%) had leukemia, and 63 (15.6%) had lymphoma. 301 (74.7%) underwent hematopoietic transplant (BMT), and 45 (11.2%) had a solid-organ transplant. 176 (43.7%) patients received chemotherapy and 261 (64.8%) received immunosuppressive drugs. The mean voriconazole total daily maintenance dose was 416.1 ± 65.9 mg (5.5 ± 1.6 mg/kg/day). Patients received inpatient voriconazole for a mean of 19.5 ± 16.5 days. 371 (92.1%) patients received a concomitant interacting drug. Only 140 (43.7%) patients had therapeutic drug monitoring. The mean first voriconazole serum concentration was 1.8 ± 1.7 mg/L. 87 (21.6%) patients discontinued voriconazole prematurely; 41 (10.2% overall) of these patients had an adverse event requiring discontinuation. 5 had breakthrough fungal infections with microbiological data identifying a fungal species, which included Rhizopus spp. among others.ConclusionVoriconazole is frequently used for primary prophylaxis of IFIs and most commonly in BMT. It appears to be relatively well tolerated with some adverse side-effects (~10%) despite many potential drug–drug interactions and provides appropriate fungal coverage for many immunosuppressed patients. However, few patients had breakthrough fungal infections while receiving voriconazole. In a real-world setting, voriconazole can provide antifungal prevention in certain high-risk patients.Disclosures All authors: No reported disclosures.

Fungal keratitis after penetrating keratoplasty

The article presents a case of fungal keratitis after penetrating keratoplasty (PKP). A 35-years old patient had previously undergone surgical removal of an intraocular foreign body and developed chronic keratouveitis and epithelial-endothelial corneal dystrophy. PKP and early postoperative period were uneventful. The patient was frequently monitored with anterior segment photos. Two weeks later, fungal keratitis occurred on the edge of the donor flap. Direct microscopic evaluation revealed fungus spores and filaments, but growth of fungi in culture was negative. Instillation of steroids and antibiotics was discontinued, specific therapy included fluconazole and amphotericin B. Despite the ongoing treatment, keratitis has repeatedly recurred, and infiltrates were scraped. Topical and systemic voriconazole was administered instead of fluconazole in combination with regular scarification. After 3 weeks of treatment with voriconazole, stable corneal epithelialization was achieved and the cornea has restored its transparency. During 1.5 years of the follow-up, keratitis did not reccur; sutures were removed, corrected visual acuity increased to 1.0. Patients who had undergone PKP are at risk of developing fungal keratitis. Frequent monitoring of such patients contributes to early diagnosis of infectious complications. In the absence of officinal antifungal eye drops, specialist has to supply the patient with ex tempore antimycotic agents and change the treatment according to its effectiveness in each specific case.

Fungal Keratitis: A Six-Year Review at a Tertiary Referral Centre.

Background This review reports the epidemiology, laboratory results, treatment regimens and costs of fungal keratitis at a tertiary referral center in Lucerne, Switzerland. Patients and Methods Culture-proven fungal infections between January 2010 and December 2015 were reviewed retrospectively. Results Seventeen patients with a mean age of 52 years were identified. Contact lens wear was the most important risk factor (n = 11) (65 % of all cases), with filamentous fungi being identified as the most common fungus type (n = 10) (91 % of all cases of contact lens-associated fungal keratitis). All non-contact lens-associated fungal infections (n = 6) (35 % of all cases) were related to Candida spp. Six patients (35 %) were treated on an outpatient basis; 11 cases (65 %) required hospitalisation. Systemic voriconazole was the treatment regimen prescribed most often (n = 12) (71 %), followed by topical natamycin 5 % (n = 11) (65 %). Corneal crosslinking and penetrating keratoplasty were required in 4 cases each (24 %). One case ended up in enucleation (6 %). Average costs per case were EUR 15 952 for hospitalised patients if surgical intervention was required, and EUR 7415 if no intervention was performed. Average costs for outpatients were EUR 7079. In a majority of cases, visual acuity could be improved (n = 9) (53 %) or preserved (n = 2) (12 %). Conclusion Despite the relatively low incidence of culture-proven keratitis (17 cases in 6 years), a clear pattern with regard to risk factors and fungus species was noted. In the absence of a gold standard for the treatment of fungal keratitis, the combination of systemic voriconazole and topical natamycin seems to be one of the most commonly used antifungal treatment regimens. The costs of outpatient versus inpatient non-surgical treatment were approximately the same.

Exophiala phaeomuriformis Fungal Keratitis: Case Report and In Vivo Confocal Microscopy Findings

Corneal infections, particularly fungal keratitis due to rare fungal species, pose a diagnostic and therapeutic challenge because of difficulty in identification and varying susceptibility profiles. In this study, we report the first case of fungal keratitis because of Exophiala phaeomuriformis. We report the clinical findings and microbial identification techniques of a case of fungal keratitis due to E. phaeomuriformis. An 84-year-old woman presented with redness, pain, and itching in the left eye for 2 weeks. Slit-lamp biomicroscopy revealed one broken suture from previous penetrating keratoplasty (PKP), black infiltrates at the 4-o'clock position, without an overlying epithelial defect and hypopyon. Microbial identification was based cultures on Sabouraud dextrose agar and DNA sequencing and correlations to laser in vivo confocal microscopy (IVCM; Heidelberg Retinal Tomograph 3/Rostock Cornea Module, Heidelberg Engineering) and multiphoton microscopy (Ultima Microscope; Prairie Technologies) images. Slit-lamp biomicroscopy revealed one broken suture from previous PKP, black infiltrates at the 4-o'clock position, without an overlying epithelial defect and hypopyon. Based on a clinical suspicion of fungal keratitis, antifungals and fortified antibiotics were started. However, the patient did not respond to therapy and required urgent PKP. After surgery, the patient was maintained on topical and systemic voriconazole and also topical 2% cyclosporine for 5 months because of possibility of scleral involvement noticed during surgery. At the end of the treatment period, her vision improved from hand motion to 20/40, with no recurrence observed in a follow-up period of 1 year. Results of diagnostic tests were supported by fungal elements in stroma on IVCM. Culture from the infiltrate grew black yeast. DNA sequencing led to the diagnosis of E. phaeomuriformis keratitis. Antifungal susceptibility testing revealed sensitivity to voriconazole. This is, to our knowledge, the first reported case of E. phaeomuriformis fungal keratitis. Diagnostic testing included slit-lamp biomicroscopy, which revealed pigmented infiltrates, culture plates grew black yeast, microscopy showed branched fungal hyphae with budding conidia, and physiological features showed tolerance to high temperatures, nitrate assimilation, and ribosomal DNA sequencing. Collectively, these tests demonstrate unique features seen for this microorganism. High suspicion should be kept with pigmented infiltrates and with dark yeast on culture plates. Prompt and aggressive medical management with voriconazole or therapeutic PKP in nonresponsive cases is essential to prevent irreversible loss of vision.

Purpureocillium lilacinum keratitis: a case series and review of the literature

ObjectiveTo describe the clinical features and risk factors of and optimal antifungal therapy for Purpureocillium lilacinum keratitis. DesignRetrospective case series in a quaternary referral hospital setting. MethodsComprehensive chart review of patients diagnosed with P. lilacinum keratitis in the past 10 years. ParticipantsFour patients were identified. All were aged 60 years or greater, with none having prior ocular trauma. Two had significant potential environmental exposure risks, and 3 were using systemic immunosuppressants for scleritis. ResultsAll cases received empirical treatment that included topical corticosteroids. Three were treated with combined oral, topical, and intracameral voriconazole, but developed endophthalmitis necessitating surgery with poor outcomes, including enucleation in 2. One case received combined oral and topical voriconazole with terbinafine, and maintained visual acuity without the need for surgery. All P. lilacinum isolates were susceptible to voriconazole. ConclusionsP. lilacinum keratitis is rare, with the major risk factor being immunosuppression. There may be no history of ocular trauma. Microbiological diagnosis and antifungal susceptibility testing is essential. Combination synergistic antifungal therapy with topical voriconazole and oral terbinafine, with addition of systemic voriconazole if needed, results in the best outcome.

Invasive Aspergillosis of Anterior Skull Base in the Immunocompetent Host: Outcomes with a Combined Treatment Modality-An Institutional Experience.

Objectives To study outcomes with voriconazole therapy in immunocompetent individuals following maximal safe endoscopic resection in invasive aspergillosis of the anterior skull base. Design Retrospective study of patients with chronic invasive aspergillosis including symptomatology, extent of disease, and response to voriconazole following maximal safe resection in immunocompetent individuals. Setting Tertiary care superspeciality referral center. Participants Ten consecutive patients of invasive aspergillosis of anterior skull base managed over a period of 2 years. Main Outcome Measures Symptom resolution with systemic voriconazole and radiologic evaluation following systemic antifungals as per predefined protocol. Conclusions Maximal safe resection via transnasal endoscopic route followed by systemic antifungals provides excellent outcomes in invasive skull base aspergillosis. Although liver and renal functions, besides visual acuity, need serial monitoring, voriconazole is well tolerated by our patients.

Fusarium Endophthalmitis following Cataract Surgery: Successful Treatment with Intravitreal and Systemic Voriconazole.

Purpose. To report a case of postoperative endophthalmitis caused by Fusarium species successfully treated with intravitreal and systemic voriconazole after treatment failure with amphotericin B. Methods. Clinical case report of a 60-year-old immunocompetent woman who presents with endophthalmitis of unknown origin 4 weeks after uneventful cataract extraction and IOL implantation surgery. IOL explantation, vitrectomy with capsular bag removal, vitreous aspiration for culture, and intravitreal injection of amphotericin B (5 μg/0.1 mL) were performed. Diagnosis was established by culturing the vitreous aspirate on a Sabouraud agar medium and staining with lactophenol blue solution. Five days later, there was no clinical response. The decision was made to administer a single dose of intravitreal voriconazole (2.5 μg/0.1 mL) and oral voriconazole (200 mg BID) for 30 days. Results. Fusarium sp. grew on culture. Treatment with local and systemic voriconazole was started after no improvement with vitrectomy, IOL explantation, and intravitreal amphotericin B. After 1 month of treatment, the infection resolved and best-corrected visual acuity was 20/25. Conclusion. In patients with endophthalmitis caused by Fusarium sp., topical and systemic voriconazole treatment should be considered in cases resistant to intravitreal amphotericin B.