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Candida auris and endogenous panophthalmitis: clinical and histopathological features
Mark P Breazzano1,2,3, Andrea A Tooley1,2,3,4,5, Kyle J Godfrey1,2,3,4
1Lenox Hill Hospital, Northwell Health, New York, NY, USA.
Purpose:
To report an unusual case of endogenous panophthalmitis involving Candida auris and describe its clinical and histopathological features.
Findings:
A 30 year-old man with history of human immunodeficiency virus, polysubstance abuse, syphilis, and recently treated pneumonia presented with polymicrobial endogenous panophthalmitis. Two separate ocular specimens confirmed simultaneous Pseudomonas aeruginosa and Candida auris involvement. Histopathological analysis demonstrated fulminant polymorphonuclear infiltration of all ocular tissue layers. Despite aggressive management including two intravitreal injections and enucleation, the patient died, ultimately after receiving care at four neighboring urban medical centers.
Conclusions And Importance:
Candida auris has been a recently and increasingly described pathogen leading to mortality in metropolitan hospitals worldwide. To the authors' knowledge, Candida auris has not previously been reported with endophthalmitis or panophthalmitis. Future cases may be expected with the reported rise in Candida auris. A high suspicion of its contribution to panophthalmitis could be warranted early in the evaluation and management of profoundly immunocompromised patients, particularly those who have had sequential care at multiple neighboring metropolitan hospitals.
Insights
This case report details a fatal instance of endogenous panophthalmitis caused by Candida auris and Pseudomonas aeruginosa in an immunocompromised patient. It highlights the emerging threat of Candida auris in severe ocular infections.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Mycology
Background:
- Candida auris is an emerging multidrug-resistant fungal pathogen causing invasive infections globally.
- Endogenous panophthalmitis is a severe intraocular infection with poor visual prognosis.
Observation:
- A 30-year-old immunocompromised male presented with polymicrobial endogenous panophthalmitis.
- Ocular specimens revealed simultaneous infection with Pseudomonas aeruginosa and Candida auris.
Findings:
- Histopathology showed extensive polymorphonuclear infiltration across all ocular tissues.
- Despite aggressive treatment including intravitreal injections and enucleation, the patient succumbed to the infection.
Implications:
- This is the first reported case of Candida auris causing endogenous endophthalmitis/panophthalmitis.
- Clinicians should consider Candida auris in immunocompromised patients with severe ocular infections, especially those with a history of multi-center care.
- The rising incidence of Candida auris necessitates heightened clinical suspicion and prompt management strategies.
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