Fungal endophthalmitis in an elderly woman: differing responses in each eye

Candida endophthalmitis is caused by hematogenous metastasis of the yeast. To ensure early diagnosis, serodiagnosis, or surveillance culturing is usually performed. If fungemia is apparent upon successive serological testing (in at least two tests: blood culture and/or measurement of β-d-glucan level), ophthalmic consultation is necessary, even if no ophthalmic complaint is evident. This is because early detection with prompt prescription of systemic antifungal agents inhibits progression of the distinctive cholioretinitis. If the initial fungemia is not promptly diagnosed, or if it is missed, fungal endophthalmitis may develop, associated with a poor prognosis in terms of visual acuity. Here, we report on a case of Candida endophthalmitis in a 92-year-old woman with severe visual disturbance in one eye that was first diagnosed on ophthalmic examination. It was already difficult to recover. Fungemic systemic/ophthalmic symptoms must be checked in the early stage; in addition, prompt ophthalmological consultation is essential.