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Endogenous Pseudallescheria boydii endophthalmitis in a patient with ring-enhancing brain lesions
1Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, Florida 33136, USA.
Abstract:
A 46-year-old man, status post liver transplantation and taking immunosuppressive medications, was admitted after suffering a generalized seizure. Magnetic resonance imaging of the brain revealed two ring-enhancing lesions and treatment was begun for presumed toxoplasmic encephalitis. He was already receiving amphotericin B for a skin lesion suspected to be caused by candidiasis. One day after the seizure, he complained of photophobia in the left eye. Intraocular inflammation and a small infiltrate in the macula were seen. Vision deteriorated over the next three days. Vitreous tap and injection of amphotericin B and vancomycin were performed, but the intraocular inflammation continued to increase. On day 15, a vitrectomy was performed. The vitreous specimen ultimately grew Pseudallescheria boydii. The patient died on hospital day 30 from complications of the brain abscesses. Pseudallescheria boydii should be considered in the differential diagnosis of endophthalmitis, especially in patients with immunosuppression, serious medical disease, or ring-enhancing brain lesions.
Insights
A rare fungal infection, Pseudallescheria boydii, caused severe brain abscesses and endophthalmitis in an immunosuppressed liver transplant patient. This case highlights the importance of considering this pathogen in complex infections.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Transplantation Medicine
Background:
- Immunosuppressed liver transplant recipients are susceptible to opportunistic infections.
- Toxoplasmic encephalitis is a common consideration for ring-enhancing brain lesions in this population.
- Amphotericin B was initially administered for suspected candidiasis.
Observation:
- A 46-year-old male presented with seizures and brain imaging revealing ring-enhancing lesions.
- Ocular symptoms including photophobia and vision loss developed, indicating endophthalmitis.
- Standard treatments for presumed toxoplasmosis and candidiasis were ineffective.
Findings:
- Vitreous culture from a vitrectomy specimen ultimately identified Pseudallescheria boydii.
- The patient succumbed to complications from disseminated disease, including brain abscesses.
- This case underscores the challenges in diagnosing and treating rare fungal infections.
Implications:
- Pseudallescheria boydii should be included in the differential diagnosis of endophthalmitis and central nervous system infections.
- Early and accurate identification of Pseudallescheria boydii is crucial for effective treatment in immunocompromised patients.
- This case emphasizes the need for broad diagnostic considerations in complex infectious disease presentations.