A novel case of Tropicoporus texanus and Aspergillus niger post-traumatic endophthalmitis

To present a case of post-traumatic fungal endophthalmitis due to novel infection with Tropicoporus texanus and co-infection with Aspergillus niger.

A 16-year-old girl developed a recalcitrant fungal endophthalmitis five weeks after sustaining a corneal laceration and traumatic cataract after accidental injury by a metal welding wire. Despite a timely initial vitrectomy with injection of intravitreal vancomycin, ceftazidime, and voriconazole as well as initiation of oral fluconazole, her endophthalmitis worsened and she developed a traction retinal detachment within one week of the procedure. She required urgent repeat vitrectomy with injection of vancomycin, ceftazidime, voriconazole, and amphotericin B as well as repair of the detachment with membranectomy and silicone oil tamponade. Intraoperative examination and post-operative tissue microscopy were concerning for invasive Aspergillus infection, prompting a transition to oral voriconazole. Symptoms and visual acuity (VA) then began to improve, with VA improving from hand motions at initial presentation to 20/200 seven months after the repeat vitrectomy despite aphakic status. Fungal cultures ultimately grew Aspergillus niger and Tropicoporus texanus.

The Tropicoporus genus has rarely been implicated in a variety of human infections including keratitis. Ophthalmologists should be aware of Tropicoporus species as a potential cause of aggressive, treatment-resistant fungal endophthalmitis.