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

ABSTRACT

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.