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.