Cladosporium Endogenous Endophthalmitis Mimicking Toxoplasma Retinochoroiditis

Area of Science:

• Ophthalmology
• Mycology
• Infectious Diseases

Background:

• Endogenous fungal endophthalmitis is a severe ocular infection, often linked to compromised immunity.
• Hematogenous spread is the primary route of infection, with Candida being the most common fungal pathogen.
• Mycotic endophthalmitis typically presents as chorioretinitis, posing a significant threat to vision.

Observation:

• A rare case of endogenous Cladosporium endophthalmitis in a diabetic patient is presented.
• The clinical presentation mimicked toxoplasma retinochoroiditis, complicating diagnosis.
• Diagnosis was confirmed by polymerase chain reaction (PCR)-based DNA sequencing of vitreous and aqueous aspirates.

Findings:

• Cladosporium cladosporioides was identified as the causative agent.
• The patient was successfully treated with a combination of intravitreal and systemic voriconazole.
• Vitreous biopsy proved essential for diagnosis when blood cultures were negative.

Implications:

• Cladosporium is an emerging cause of endogenous endophthalmitis, requiring increased clinical awareness.
• This case highlights the importance of considering rare fungal pathogens in endophthalmitis diagnosis.
• Effective management involves prompt diagnosis and targeted antifungal therapy, including intravitreal voriconazole.