Endogenous mycotic endophthalmitis in an immunocompetent postpartum patient

The purpose of this study was to report endogenous mycotic endophthalmitis in an immunocompetent postpartum patient who has undergone perineotomy in childbirth.

A 29-year-old immunocompetent postpartum woman had floaters in the left eye 2 weeks after childbirth. She denied ocular trauma, previous intraocular surgery, or intravenous drug use. The best-corrected visual acuity was 20/100 in the left eye. Anterior chamber cells, keratic precipitates, vitreous cells, and retinal infiltration were found. Endogenous endophthalmitis was highly suspected. The survey for infectious source was negative, but the culture of aqueous humor showed the presence of Cladosporium species. Pars plana vitrectomy and intravitreal 1 -μg fluconazole injection were performed. The culture of the vitreous disclosed Candida albicans. Intravitreal injections with 5 μg amphotericin-B and 0.1 mg voriconazole were given subsequently. Intravenous voriconazole 200 mg twice daily was administered for 2 weeks and was shifted to the oral form for 4 more weeks.

A residual retinal exudate resolved during follow-up. The best-corrected visual acuity was 20/25 in the left eye 10 months later.

This is the first case that illustrates the occurrence of endogenous mycotic endophthalmitis culture proved by Candida and Cladosporium in an immunocompetent patient. Early detection and appropriate treatment preserved vision.