Chronic exogenous exophiala dermatitidis endophthalmitis

Area of Science:

• Ophthalmology
• Mycology
• Infectious Diseases

Background:

• Fungal keratitis is a significant cause of visual impairment.
• Exogenous endophthalmitis is a severe intraocular infection, often sight-threatening.

Observation:

• A 60-year-old male with a history of herpes zoster keratitis and fungal keratitis developed endophthalmitis.
• Diagnostic vitrectomy confirmed Exophiala dermatitidis as the causative agent.
• Despite aggressive antifungal treatment, the infection recurred, necessitating enucleation.

Findings:

• Polymerase chain reaction and culture identified Exophiala dermatitidis in intraocular fluid.
• Histopathology of the enucleated eye confirmed filamentous fungi consistent with E. dermatitidis.
• The patient experienced recurrent corneal infection and chronic uveitis.

Implications:

• Exophiala species, though rare, are a potential cause of exogenous endophthalmitis.
• Persistent intraocular inflammation after infectious keratitis should raise suspicion for chronic endophthalmitis.
• This case highlights the importance of considering fungal etiology in complex post-keratitis intraocular inflammation.