Posttraumatic Aspergillus terreus endophthalmitis masquerading as dispersed lens fragments

A 20-year-old man developed increasing inflammation with a hypopyon 3 weeks after primary repair of a corneal laceration. An occult anterior capsule puncture was suspected as the stimulus for the inflammation. When aspiration of the suspected hydrated lens material was not curative, a vitrectomy with injection of intravitreal antibiotic agents including amphotericin (0.0125 mg) was done the following day; the culture failed to grow fungal organisms. A repeat vitrectomy was performed 1 week later, and the culture grew Aspergillus terreus. This was determined to be resistant to amphotericin so voriconazole was injected intravitreally. The inflammation recurred, and the eye required enucleation because of blindness and intractable pain. Fungal endophthalmitis should be considered in cases of delayed-onset inflammation after trauma and may be due to organisms resistant to amphotericin.