ENDOGENOUS FUNGAL ENDOPHTHALMITIS FOLLOWING COVID-19 INFECTION: CASE REPORT AND REVIEW OF LITERATURE.

ABSTRACT

PURPOSE: To describe a case of endogenous endophthalmitis (EE) following severe COVID-19 disease, review patient outcomes with EE following COVID-19 infection, review evidence regarding risk factors for developing EE. METHODS: Review of health records, imaging, intravitreal injection, and pars plana vitrectomy for bilateral fungal EE following severe COVID-19 disease. Literature review on outcomes in EE following COVID-19 disease. RESULTS: 63 year-old male with diabetes and hypertension was admitted to hospital for severe COVID-19 disease for 3 months. His stay required ICU admission, intubation, high-dose corticosteroids, tocilizumab, and was complicated by bacteremia, empyema, and fungal esophagitis. He developed floaters and bilateral vision loss (visual acuity 20/40 OD, CF OS) with vitritis 2.5 months into his stay that did not respond to intravitreal voriconazole. Pars plana vitrectomy was performed for both eyes, resulting in visual acuity of 20/40 OD, 20/30 OS. Vitreous cultures were positive for candida albicans. EE following COVID-19 disease has been reported in 22 patients to date, and outcomes are poor, with 40%+ of eyes legally blind (20/200 or worse). Although influenced by availability of imaging modalities and degree of training of the evaluating physician, misdiagnosis can affect » of cases, delaying treatment. Age, male gender, and diabetes increase risk of severe COVID-19, which requires prolonged hospitalization, invasive catheretization, and immunosuppression, which in turn increases risk of nosocomial infection. CONCLUSION: Low threshold for suspecting endogenous endophthalmitis in patients presenting with floaters and decreased vision following severe COVID-19 disease is necessary to ensure prompt recognition and treatment.