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Endogenous endophthalmitis due to Fusarium: case report and review
Abstract:
Endogenous fungal endophthalmitis is being increasingly recognized in susceptible individuals. We report a case of endogenous endophthalmitis due to Fusarium solani that occurred as the sole clinical manifestation of fungal disease in an immunocompromised host. Four previously reported cases of endogenous fusarial endophthalmitis are also reviewed. Two of these patients had no underlying disease and presented with isolated endophthalmitis, while two other patients had acute leukemia and presented with multiple organ involvement due to Fusarium. All three patients with leukemia, including our patient, were severely neutropenic at the time of diagnosis. Two of these three patients had fungemia. MICs of amphotericin B for fungal isolates ranged from 0.14 to 10 micrograms/mL. Despite abatement of the endophthalmitis after antifungal therapy and vitrectomy, the prognosis for immunocompromised patients remains guarded because of underlying disease.
Insights
Endogenous fungal endophthalmitis, particularly Fusarium solani infections, is a growing concern in immunocompromised patients. Early diagnosis and treatment are crucial, but prognosis remains guarded due to underlying conditions.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Endogenous fungal endophthalmitis is an emerging threat in immunocompromised individuals.
- Fungal infections, especially Fusarium species, are increasingly implicated.
Observation:
- A case of endogenous endophthalmitis caused by Fusarium solani is presented as the sole manifestation of fungal disease in an immunocompromised host.
- A review of four prior cases highlights varied presentations, from isolated endophthalmitis to disseminated Fusarium infection in leukemia patients.
- Severe neutropenia was noted in all three leukemia patients, with two experiencing fungemia.
Findings:
- Fusarium solani can cause endogenous endophthalmitis as a primary or sole clinical sign.
- Antifungal therapy (amphotericin B) showed variable Minimum Inhibitory Concentrations (MICs) ranging from 0.14 to 10 µg/mL.
- Successful treatment of endophthalmitis was achieved with antifungal therapy and vitrectomy.
Implications:
- Early recognition and prompt intervention are vital for managing fungal endophthalmitis.
- The prognosis for immunocompromised patients with fungal endophthalmitis remains guarded due to the severity of underlying diseases.
- This case underscores the importance of considering fungal infections in the differential diagnosis of endophthalmitis, especially in susceptible populations.