Exogenous cryptococcal endophthalmitis in an immunocompetent patient

Area of Science:

• Ophthalmology
• Infectious Diseases
• Mycology

Background:

• Exogenous fungal endophthalmitis is a rare intraocular infection.
• Cryptococcus species are an uncommon cause of endophthalmitis, particularly in immunocompetent individuals.
• Ocular infections can occur without systemic dissemination or central nervous system (CNS) involvement.

Observation:

• An 82-year-old immunocompetent male with multiple comorbidities presented with chronic left eye pain and redness.
• Vitreous cultures confirmed Cryptococcus species as the causative agent of endophthalmitis.
• Extensive workup ruled out CNS involvement, systemic cryptococcosis, and underlying immunocompromising conditions.

Findings:

• The patient received treatment with intravitreal amphotericin B and systemic antifungals.
• The treatment regimen led to subjective improvements in clinical examination and visual acuity.
• This case represents a rare instance of localized ocular infection by Cryptococcus.

Implications:

• Highlights the importance of considering fungal endophthalmitis in immunocompetent patients with unexplained uveitis or endophthalmitis.
• Suggests that intravitreal and systemic antifungal therapy can be effective in managing exogenous cryptococcal endophthalmitis.
• Emphasizes the need for thorough diagnostic workup to exclude systemic or CNS involvement, even in localized presentations.