ASPERGILLUS ENDOPHTHALMITIS SECONDARY TO INFECTIOUS SCLERITIS: UTILITY OF DIAGNOSTIC POLYMERASE CHAIN REACTION

Area of Science:

• Ophthalmology
• Infectious Diseases
• Medical Mycology

Background:

• Fungal scleritis and endophthalmitis are rare but serious ocular infections.
• Delayed diagnosis can lead to significant visual morbidity and potential loss.
• Aspergillus fumigatus is a common fungal pathogen implicated in ocular infections.

Purpose of the Study:

• To report a case of delayed-onset Aspergillus fumigatus endophthalmitis.
• To highlight the secondary development of endophthalmitis from infectious fungal scleritis.
• To demonstrate the utility of broad range polymerase chain reaction (PCR) in diagnosis.

Main Methods:

• Retrospective case report.
• Clinical examination including slit lamp photography, optical coherence tomography, and fundus photography.
• Diagnostic vitrectomy with vitreous sampling and scleral nodular debridement for broad range PCR and cultures.

Main Results:

• A 76-year-old male presented with worsening vision and pain eight months post-ocular injury.
• Infectious workup was initially negative; patient received anti-inflammatory treatment.
• Broad range PCR of vitreous and scleral samples confirmed Aspergillus fumigatus, leading to targeted antifungal therapy.

Conclusions:

• Fungal scleritis and endophthalmitis carry a high risk of morbidity.
• Diagnostic vitrectomy and broad range PCR are crucial for prompt and accurate diagnosis.
• This approach facilitates targeted antifungal treatment, especially in refractory cases.