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Atypical Panuveitis in Disseminated Coccidioidomycosis.

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Coccidioides immitis can cause severe vision loss from fungal endophthalmitis in at-risk patients. Early diagnosis and treatment, including antifungal therapy, are crucial for better outcomes.

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CoccidioidomycosisEndophthalmitisIntravitreal AntifungalsUveitisViscous Hypopyon

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Area of Science:

  • Ophthalmology
  • Mycology
  • Infectious Diseases

Background:

  • Endogenous fungal endophthalmitis poses diagnostic and therapeutic challenges.
  • Coccidioides immitis is an emerging cause of fungal endophthalmitis, especially in endemic regions and immunocompromised individuals.

Purpose of the Study:

  • To review diagnostic hurdles and treatment approaches for Coccidioides immitis-induced endogenous fungal endophthalmitis.
  • To emphasize the importance of timely diagnosis and management in at-risk populations.

Main Methods:

  • Analysis of two clinical cases of endogenous fungal endophthalmitis.
  • Evaluation of diagnostic timelines, clinical presentations, and treatment outcomes.
  • Focus on patients with systemic risk factors for coccidioidomycosis.

Main Results:

  • Delayed diagnosis via vitreous culture (19-28 days) was observed in both cases.
  • One patient with disseminated coccidioidomycosis showed improvement with combined antifungal therapy (vision to 20/150).
  • Another patient with a history of liver transplantation experienced partial vision recovery (counting fingers) with empiric antifungals.

Conclusions:

  • Coccidioidomycosis can lead to vision-threatening endophthalmitis, particularly in immunosuppressed individuals and those in endemic areas.
  • Culture-based diagnostic delays highlight the utility of serological tests.
  • Multidisciplinary care, prompt empiric antifungal treatment, and long-term monitoring are essential for managing this condition and preventing recurrence.