Endogenous Candida Endophthalmitis

A patient presented with blurry vision and floaters in the left eye for 2 weeks. His history was notable for a recent hospitalization for a non-healing foot ulcer, for which he underwent wound debridement and bone cultures. He was also being evaluated for suspected hepatocellular carcinoma. On presentation, his vision was 20/20 OD and 20/150 OS. His intraocular pressures were normal. The anterior exam was notable for anterior chamber and vitreous inflammation in the left eye. Dilated fundus exam of the left eye showed a hazy view, heme in the macula, and two or three white chorioretinal lesions posteriorly with overyling vitritis. Given concern for endogenous endophthalmitis, the patient underwent vitreous and anterior chamber paracentesis, and he received intravitreal vancomycin, ceftazidime, and voriconazole. He was admitted to the hospital for infectious work-up, but no infectious source was identified during his inpatient stay. The vitreous and anterior chamber cultures showed no growth. On follow-up at Bascom Palmer, his vision worsened despite oral voriconazole and multiple intravitreal injections of voriconazole, and he was taken to the OR for diagnostic vitrectomy and intra-operative injection of voriconazole. Post-operatively, the patient did well. His vision improved to 20/20 OS by post-op week three. The vitreous cultures taken intraoperatively grew Candida albicans.

Presentation Date: 06/06/2024

Issue Date: 06/28/2024