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L Simon1, L Gastaud2, D Martiano3
1Laboratoire de parasitologie-mycologie, hôpital de l'Archet, centre hospitalier universitaire de Nice, 151, route de Saint-Antoine-de-Ginestière CS 23079, 06202 Nice cedex 3, France.
Abstract:
Endophthalmitis is a rare infection of the vitreous and/or aqueous. It can be bacterial or fungal. Exogenous endophthalmitis is the most common form and results from direct inoculation of a pathogen after eye surgery or penetrating trauma. Endophthalmitis can also be endogenous, secondary to disseminated infection. Fungal endophthalmitis is associated with poor prognosis and treatment is difficult given the low penetration of most of the antifungal agents available and the emergence of resistant filamentous fungi like Fusarium. To our knowledge, we describe the first endogenous fungal endophthalmitis due to Fusarium dimerum, a ubiquitous pathogen found in soil and plants. A 71-year-old woman, diagnosed with acute myeloid leukemia, was hospitalized for surveillance after induction chemotherapy. Prophylaxis by antibiotics and posaconazole was ongoing when she complained of pain and decreased vision in the left eye. A voluminous chorioretinal abscess developed and after multiple sterile aqueous humour samples, only vitrectomy allowed diagnosis with fungal hyphae seen on May-Grünwald Giemsa stained smear and positive cultures. The fungus was identified as Fusarium dimerum. The treatment, that included intravitreal injections of voriconazole and amphotericin B associated with systemic administration of voriconazole, allowed complete control of the infection. The source of this infection could not be confirmed despite the discovery of several possible infection sites including a periungual whitlow on the left hand and a lesion on a nail, from which samples were negative in microbiology laboratories. Unfortunately, damages of the retina were too important and the patient did not recover sight of her left eye.
Insights
This study reports the first case of endogenous fungal endophthalmitis caused by Fusarium dimerum in an acute myeloid leukemia patient. Prompt treatment with voriconazole and amphotericin B controlled the rare eye infection.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Endophthalmitis is a severe intraocular infection, with fungal forms posing significant treatment challenges due to poor antifungal penetration and emerging resistance.
- Fusarium species are common soil and plant pathogens, rarely implicated in endogenous endophthalmitis.
Purpose of the Study:
- To describe the first documented case of endogenous fungal endophthalmitis caused by Fusarium dimerum.
- To highlight the diagnostic and therapeutic approach for this rare clinical entity.
Main Methods:
- A case report of a 71-year-old female patient with acute myeloid leukemia undergoing chemotherapy.
- Diagnosis was confirmed via vitrectomy, identifying fungal hyphae and positive cultures for Fusarium dimerum.
- Treatment involved intravitreal voriconazole and amphotericin B, plus systemic voriconazole.
Main Results:
- The patient developed endogenous fungal endophthalmitis due to Fusarium dimerum, despite antifungal prophylaxis.
- Vitrectomy was crucial for diagnosis, revealing fungal hyphae and enabling pathogen identification.
- Combined intravitreal and systemic antifungal therapy achieved complete infection control.
Conclusions:
- Fusarium dimerum can cause endogenous endophthalmitis, even with antifungal prophylaxis, particularly in immunocompromised patients.
- Aggressive and timely treatment with voriconazole and amphotericin B is essential for managing this sight-threatening condition.
- Despite successful infection control, significant retinal damage resulted in vision loss.