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SEGMENTAL PATTERN OF INFILTRATES OVER RETINAL VESSELS IN FUNGAL ENDOPHTHALMITIS
1Department of Ophthalmology, Kaiser Permanente, Tustin, California.
Purpose:
To describe the case of a patient with Candida tropicalis endophthalmitis who presented with a pattern of segmentally distributed preretinal infiltrates overlying the retinal blood vessels.
Methods:
A retrospective chart review was performed. A 72-year-old East Indian male presented with redness, pain, photosensitivity, and loss of vision in the right eye for 1 month. He had been recently hospitalized for necrotizing pancreatitis and had been receiving intravenous medications as well as parenteral nutrition through a peripherally inserted central catheter.
Results:
Fundus examination revealed moderate vitreous cells and infiltrates, including a segmental pattern of preretinal bead-like opacities along several blood vessels. The patient underwent emergent vitrectomy with injection of antibiotics and antifungal medications. Vitreous cultures grew C. tropicalis. The patient was treated with oral antifungal medication for 6 weeks. By 7 weeks after surgery, all infiltrates and inflammatory cells had completely resolved. The imaging and intraoperative observations suggest that the opacities behaved like infiltrates and were associated with vitreous rather than vascular inflammation.
Conclusion:
A segmental pattern of preretinal infiltrates over retinal vessels can be a presenting feature in endogenous fungal endophthalmitis. The observations in this case may contribute to understanding the pathophysiology of the findings.
Insights
A case of Candida tropicalis endophthalmitis presented with unique segmental preretinal infiltrates. Early diagnosis and treatment led to complete resolution, highlighting a key diagnostic feature of fungal endophthalmitis.
Area of Science:
- Ophthalmology
- Medical Mycology
- Infectious Diseases
Background:
- Endogenous fungal endophthalmitis is a severe intraocular infection.
- Candida tropicalis is an opportunistic pathogen that can cause endophthalmitis, particularly in immunocompromised individuals.
- Risk factors include recent hospitalization, intravenous medications, and parenteral nutrition.
Observation:
- A 72-year-old male presented with a month of right eye redness, pain, photosensitivity, and vision loss.
- Fundus examination revealed vitreous cells and infiltrates with a segmental pattern of preretinal opacities along retinal blood vessels.
- The patient had a history of necrotizing pancreatitis and central venous catheter use.
Findings:
- Vitreous cultures confirmed Candida tropicalis infection.
- The preretinal opacities were consistent with infiltrates associated with vitreous inflammation.
- Emergent vitrectomy with antifungal and antibiotic injection, followed by oral antifungal treatment, led to complete resolution.
Implications:
- Segmental preretinal infiltrates overlying retinal vessels can be an early presenting sign of endogenous fungal endophthalmitis.
- This case expands the understanding of the clinical manifestations and pathophysiology of Candida endophthalmitis.
- Prompt recognition and management are crucial for favorable visual outcomes in fungal endophthalmitis.
