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Chronic basidiomycetous endophthalmitis after extracapsular cataract extraction and intraocular lens implantation
K U Bartz-Schmidt1, K Tintelnot, M Steffen
1Department of Ophthalmology, University of Cologne, Germany.
Background:
Basidiomycetes are known as rare pathogens for meningitis, sinusitis, pneumonia, ulcerative lesions of the hard palate and onychomycosis. To our knowledge, no filamentous basidiomycete has been reported from a case of fungal endophthalmitis.
Patient:
We report on a 67-year-old man with delayed-onset endophthalmitis caused by an opportunistic basidiomycete. Tissue obtained during vitrectomy was cultured and examined by light and transmission electron microscopy. After enucleation the eye was examined by light microscopy.
Conclusion:
The patient had endophthalmitis from a sterile hyphomycete, harboured in remnants of lens capsule and a granuloma on the ciliary body. It was recognized as a Holobasidiomycete on the basis of its dolipore structure with perforated pore cap, seen with transmission electron microscopy. Species identification was not possible because fruiting bodies were absent. The patient failed to respond to intravitreal and systemic amphotericin B and systemic itraconazole. The eye was enucleated. This case demonstrates that filamentous basidiomycetes can cause endophthalmitis when inoculated during cataract extraction.
Insights
A rare filamentous basidiomycete caused fungal endophthalmitis in a patient post-cataract surgery. This case highlights the potential for these fungi to cause severe eye infections, even when rare.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Basidiomycetes are infrequently implicated as human pathogens, typically causing superficial infections.
- Filamentous basidiomycetes have not previously been documented as causative agents of fungal endophthalmitis.
Observation:
- A 67-year-old male developed delayed-onset endophthalmitis following cataract extraction.
- Microscopic examination of ocular tissue revealed a sterile hyphomycete, identified as a Holobasidiomycete based on its characteristic dolipore septa.
Findings:
- The infection was caused by an opportunistic filamentous basidiomycete.
- The fungus was found within lens capsule remnants and a ciliary body granuloma.
- Species-level identification was precluded by the absence of fruiting bodies.
Implications:
- This case establishes filamentous basidiomycetes as a potential cause of endophthalmitis, particularly after intraocular surgery.
- The patient's poor response to standard antifungal treatments (amphotericin B, itraconazole) underscores the challenges in managing such infections.
- Ocular fungal infections require careful diagnosis and consideration of less common etiologies.