Endogenous Candida Endophthalmitis
Endogenous endophthalmitis is an ophthalmic emergency that requires prompt recognition, treatment, and full systemic workup to identify the source of the infection. This case describes a male with a past medical history of diabetes, hypothyroidism, and nephrolithiasis with a ureteral stent who presented to the Bascom Palmer Emergency Department after referral from an outside ophthalmologist for “bilateral retinal lesions”. The patient was recently hospitalized for surgical removal of his ureteral stent, and his course was complicated by candidemia for which he received systemic antifungal therapy. The patient was completely asymptomatic from a visual perspective, though his visual acuity was 20/40 OD and 20/20 OS. His intraocular pressures were 13 and 14, respectively. Slit lamp exam was significant for 1+ cell in the anterior chamber and anterior vitreous, and dilated fundus exam was significant for bilateral, white, fluffy lesions in the posterior pole. Optical coherence tomography revealed full thickness hyperreflective lesions with overlying vitritis that corresponded to the white fungal lesions on fundus photography. An anterior chamber paracentesis was performed along with intravitreal injection of vancomycin, ceftazidime, and voriconazole. The anterior chamber paracentesis did not identify any pathogens. The patient was then transferred to the nearest hospital for a systemic workup where he was found to have a collection of loculated fluid in the left retroperitoneum. After aspiration and culture of this fluid, it was found to be positive for Candida albicans. He received intravenous fluconazole throughout his hospital course and was discharged on oral fluconazole for at least 4 weeks. Unfortunately, the patient was lost to follow up, so his ophthalmologic clinical course was unable to be further investigated.
Presentation Date: 09/19/2024
Issue Date: 10/24/2024
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