Fungal endophthalmitis: an unusual complication of GI surgery and endoluminal vacuum therapy

Area of Science:

• Ophthalmology
• Infectious Diseases
• Surgical Site Infections

Background:

• Endogenous fungal endophthalmitis is a severe intraocular infection.
• Gastrointestinal surgery can lead to complications like anastomotic leaks and sepsis.
• Endoluminal vacuum therapy is used for managing surgical complications like pre-sacral collections.

Observation:

• A patient developed a pre-sacral collection post-ileoanal pouch formation, treated with endoluminal vacuum therapy (Endo-SPONGE) and antibiotics.
• Despite treatment, the patient experienced recurrent sepsis and the collection size did not decrease.
• Ocular symptoms, including red eyes and blurred vision, led to the diagnosis of fungal endophthalmitis.

Findings:

• Candida species were identified in extended fungal cultures of the Endo-SPONGE device and pouch effluent.
• This is the first reported case of fungal endophthalmitis associated with the use of endoluminal vacuum therapy.

Implications:

• The findings underscore the importance of considering fungal infections in patients with persistent sepsis after gastrointestinal surgery.
• Routine fungal cultures should be considered in cases of unexplained or recurrent sepsis, especially when using devices like Endo-SPONGE.
• Early diagnosis and appropriate antifungal treatment are crucial for managing fungal endophthalmitis and improving patient outcomes.