A case of endogenous candida endophthalmitis with incidental cytomegalovirus infection and optic neuropathy in a patient recovered from severe COVID-19

A 62-year-old female diabetic recovered from COVID-19 pneumonia after receiving a prolonged course of steroids. She presented with a clinical picture of left-eye panuveitis with white cotton ball chorioretinal lesions and RAPD suggesting an optic neuropathy (VA HM). Diagnostic vitrectomy was performed to take samples for infective screen and to give intravitreal voriconazole empirically. Smear, culture, and PCR for viral DNA confirmed mixed infection of endogenous Candida endophthalmitis and incidental CMV infection. With further treatment, her corrected vision improved to 6/18 with regressing fungal lesions in serial fundus photographs. Prompt diagnosis and intervention preserved her vision and prevented potential life-threatening complications

A Case of Fungal Endophthalmitis after Having Received Extraction of Wisdom Tooth in Healthy Woman

PURPOSE: To report a case of candida endogenous endophthalmitis in healthy women who had received extraction of wisdom tooth. CASE SUMMARY: A 65-year-old medically healthy woman who had received extraction of wisdom tooth two weeks ago, presented with floater symptoms in her left eye. Best-corrected visual acuity was 20/40 and intraocular pressure was 17 mmHg in her left eye. Inflammatory cells were found in the anterior chamber and vitreous. Fluorescein angiography showed multiple hypofluorescence without vascular leakage. With provisional diagnosis of intermediate uveitis, she was prescribed oral steroid for two weeks. After that, inflammatory cells in anterior chamber was reduced but vitreous imflammatory cell was increased and fundus examination detected newly developed infiltrated lesion at superotemporal area. The patient was presumed to have fungal endophthalmitis and immediate intravitreal voriconazole injection was performed. Three days after intravitreal voriconazole injection, diagnostic vitrectomy and intravitreal voriconazole injection were performed. Vitreous cultures revealed the growth of Candida albicans. Despite the treatment, inflammatory response in anterior chamber and vitreous rapidly increased and visual acuity was decreased to hand movement. We changed anti-fungal agent, voriconazole to Amphotericin B. Additional three-time intravitreal injection was done and therapeutic vitrectomy with oil injection were performed. After treatment, the patient's fundus markedly improved and inflammatory response was decreased. CONCLUSIONS: This case report shows candida endophthalmitis in healthy woman who had received extraction of wisdom tooth. So to diagnose endophthalmitis, patient's medical history should carefully be checked including dental care history who presented with vitreous inflammation and inflammatory infiltrated lesion at fundus.

Successful management of presumed Candida endogenous endophthalmitis with oral voriconazole.

Endogenous fungal endophthalmitis is most commonly caused by Candida species and usually occurs in patients with chronic diseases such as diabetes mellitus and renal insufficiency. Voriconazole, a broad-spectrum triazole antifungal agent, attains therapeutically significant concentrations in the vitreous cavity after systemic administration. We report, the successful management of presumed endogenous Candida endophthalmitis in a patient with multiple diseases and unstable systemic status with oral voriconazole. Though fungal endophthalmitis has been successfully treated with a combination of intravenous and intravitreal voriconazole, to the best of our knowledge this is the first report in ophthalmic literature (Medline Search) on the treatment of fungal endophthalmitis with only the oral route of administration of voriconazole.

Endogenous Candida Endophthalmitis with Bilateral Massive Submacular Abscess

PURPOSE: We present a case of endogenous endophthalmitis in which the patient presented with an overall clinical picture suggestive of bacterial endophthalmitis but was subsequently found to have Candida endophthalmitis. CASE SUMMARY: A 50-year-old man with hepatic encephalopathy and alcoholic liver cirrhosis who was treated in gastroenterology presented with reduced vision in both eyes. Indirect ophthalmoscopy showed bilateral massive submacular abscesses and surrounding retinal hemorrhage. In view of the initial fundal picture of a submacular abscess lesion, the subacute course of the disease, and a medical history of diabetes and liver cirrhosis, a provisional diagnosis of bacterial endophthalmitis was made. Treatment with topical and systemic empirical antibiotics was immediately initiated. CONCLUSIONS: Candida albicans should be considered in the differential diagnosis of endogenous endophthalmitis when massive submacular abscesses and hemorrhage are seen.

Candida guilliermondii Endophthalmitis in a Patient with Mixed Gastrointestinal Stromal Tumor and Stomach Adenocarcinoma

Candida is the most common etiologic agent causing endogenous endophthalmitis resulting due to hematogenous spread from a remote primary focus. Risk factors for the infection include intravenous drug use, hyperalimentation, surgery, malignancy, diabetes, neutropenia, and the use of broad- spectrum antibiotics and immunosuppressive agents, especially corticosteroids. The outcome of candida endophthalmitis is disappointing. One main problem in the management of this infection is that early diagnosis is difficult. Thus, treatment may be delayed and this which often leads to a poor outcome. Candida endophthalmitis, particularly candida guilliermondii endophthalmitis, is extremely rare, although it is becoming more common as the number of chronically debilitated patients and the use of invasive procedures increase. It is an ophthalmologic emergency and commonly takes a tragic course. Therefore, early suspicion and aggressive management are imperative to prevent visual loss. The authors report a case of candida endophthalmitis caused by Candida guilliermondii in a 65-year-old man with mixed gastrointestinal stromal tumor(GIST) and stomach adenocarcinoma.

Candida guilliermondii Endophthalmitis in a Patient with Mixed Gastrointestinal Stromal Tumor and Stomach Adenocarcinoma

Candida is the most common etiologic agent causing endogenous endophthalmitis resulting due to hematogenous spread from a remote primary focus. Risk factors for the infection include intravenous drug use, hyperalimentation, surgery, malignancy, diabetes, neutropenia, and the use of broad- spectrum antibiotics and immunosuppressive agents, especially corticosteroids. The outcome of candida endophthalmitis is disappointing. One main problem in the management of this infection is that early diagnosis is difficult. Thus, treatment may be delayed and this which often leads to a poor outcome. Candida endophthalmitis, particularly candida guilliermondii endophthalmitis, is extremely rare, although it is becoming more common as the number of chronically debilitated patients and the use of invasive procedures increase. It is an ophthalmologic emergency and commonly takes a tragic course. Therefore, early suspicion and aggressive management are imperative to prevent visual loss. The authors report a case of candida endophthalmitis caused by Candida guilliermondii in a 65-year-old man with mixed gastrointestinal stromal tumor(GIST) and stomach adenocarcinoma.

Effect of Dexamethasone on Experimental Candida Endophthalmitis

The use of intravitreal corticosteroids in the management of endophthalmitis remains controversial. This study was performed to evaluate the effectiveness of dexamethasone(DXM) in Candida endophthalmitis. In rabbits, Candida albicans(3,000 blastospore: Group A, 30,000 blastopore: Group B) was inoculated intrabitreally. At 24, 48, and 72 hours postinoculation, single intravitreal dose of amphotericin B(AMP, 5microgram/0.1ml) with DXM(400microgram/0.1ml) or AMP alone was given. Clinical examination, protein analysis, electrophysiological and histopathologic measures were utilized to rate DXM effectiveness. Dosage of 5microgram AMP resulted in no culture in both Group A and B, On examinations including the electrophysiologic and histopathologic studies, eyes treated with AMP and DXM did not differ from eyes treated with AMP alone in the Group A(p>0.05). On protein analysis for vitreous in the Group B, however, eyes treated with AMP alone at 24 and 48 hours postinoculation(p<0.05). On electrophysiologic study the decrease rate of the amplitude showed the difference between at 24 hours postinoculation and at 48 or 72 hours postinoculation(p<0.05). Histologic preparations showed a mild or moderate cellular infilteration in the vitreous and swelling in the sensory retina, but small abscess in the vitreous observed when treatment was delayed more than 72 hours following inoculation in both Group A and B. DXM in the experimental Candida endophthalmitis had the beneficial effect in eyes with 30,000 blastspore inoculation and in eyes treated with AMP and DXM at 24 hours postinoculation.

A Case of Candida Endophthalmitis

Candida chorioretinitis is the most common fungal infection of the retina and choroid, and is one of the most common of all endogenous infections of the eye. The typical lesion of candida chorioretinitis is a white, circumscribed lesion, less than 1 mm in diameter, with an overlying haze of vitreous inflammatory cells. There may be vascular sheathing of retinal vessels in the area surrounding the lesions. Candida Endophthalmitia is defined as chorioretinitis with extension into vitreous or with intravitreal "puff balls". It has become an increasingly important cause of nosocomial infection, and has been documented in 9.9 % to 37% of adult patients with candidemia. We successfully treated one case of candida endophthalmitis with systemic administration of amphotericin B, itraconazole and intravitreal injection of amphotericin B in 18-year-old male after flame burn injury. We also performed pars plana vitrectomy with membrane peeling for the purpose of relieving preretinal traction membrane which had occurred after resolution of candida chorioretinitis.