Topic outline

  • Grand Rounds

    A middle-aged immunocompetent patient with hyperlipidemia and controlled Type 2 Diabetes Mellitus presented with rapid vision loss in the right eye and floaters in the left eye. Review of systems was significant for right sided headache, abdominal pain, nausea, and vomiting. Vision was Counting Fingers in the right eye and 20/300 in the left eye. Dilated fundus exam was significant for a large sub-macular lesion with overlying hemorrhage in the right eye and a small focus of retinal whitening with overlying vitritis in the left eye. Both eyes had Roth spots peripherally. The patient underwent vitreous tap and injection of intravitreal vancomycin, ceftazidime, and voriconazole in both eyes. The patient was referred to the hospital for systemic workup which later revealed mitral valve endocarditis. The patient later developed thrombosis of the celiac and superior mesenteric artery as well as a cerebral mycotic aneurysm. The causative organism was made by Karius test, which identified Aspergillus species. The patient later underwent mitral valve replacement as well as repair of the cerebral mycotic aneurysm and vascular occlusions. All surgical pathology demonstrated fungal elements. Culture from the mitral valve grew Aspergillus fumigatus. Bilateral endogenous endophthalmitis was treated with repeated intravitreal injections including voriconazole, as well as systemic voriconazole and amphotericin B. Visual acuity remained poor, however final visual acuity was unable to be assessed due to neurologic deficits.

    Presentation Date: 07/18/2024
    Issue Date: 08/09/2024