Title: Ocular Candidiasis
Authors: Christopher D. Conrady, MD, PhD, Rachel Jacoby, MD, Akbar Shakoor, MD, and Paul Bernstein MD, PhD
Keywords/Main Subjects: candidiasis, endophthalmitis, fungal endophthalmitis
Diagnosis/Differential Diagnosis: Presumed Candida endophthalmitis
Brief Description of Case: In the following cases, we present a 13-year-old boy that was being treated for B cell ALL. He developed a fever of unknown origin and was subsequently found to have GI imaging findings consistent with systemic candida. Blood cultures remained negative. Due to concern for candida, ophthalmology was asked to evaluate the patient and he was subsequently found to have two chorioretinal lesions of the left eye. He was initially closely monitored on IV antifungal therapy but then required intraocular injections, and finally, a pars plana vitrectomy due to re-activation of the lesions. Unfortunately, no microbiology could help direct therapy in this case and the full case is seen in detail in the presentation.
Slides 4, 5, 9, 10, 11, 14, and 17 are dilated fundus photographs. Slide 14 specifically shows the re-activation of the lesion once the patient was transitioned to oral antifungals as seen with the hazy borders and enlarged size compared to prior images.
Slide 21: Denotes a second case of presumed candida fungal endophthalmitis in a 10-year-old boy being treated for ALL. He has two notable peripheral lesions in the left eye. Due to their non-central nature, the spots were monitored closely and remained unchanged while on anti-fungal therapy. His other eye (not shown) had a foveal-involving lesion that required intravitreal antifungal therapy in addition to systemic antifungals.
Summary of Cases:
These two cases highlight the medical and surgical management of fungal endophthalmitis.
References for further reading:
- Brod RD, Flynn HW Jr., Clarkson JG, Pflugfelder SC, Culbertson WW, Miller D. Endogenous Candida endophthalmitis: management without intravenous amphotericin B. Ophthalmology 1990;97:666-72.
- Essman TF, Flynn HW Jr, Smiddy WE, Brod RD, Murray TG, Davis JL. Treatment outcomes in a 10-year study of endogenous fungal endophthalmitis. Ophthalmic Surg Lasers. 1997 Mar. 28(3):185-94.
- Hariprasad SM, Mieler WF, Holz ER, et al. Determination of vitreous, aqueous, and plasma concentration of orally administered voriconazole in humans. Arch Ophthalmol 2004;122:42-7.
- O’Day DM, Head WS, Robinson RD, Stern WH, Freeman JM. Intraocular penetration of systemically administered antifungal agents. Curr Eye Res 1985;4:131-4.
- Paulus YM, Cheng S, Karth PA, Leng T. PROSPECTIVE TRIAL OF ENDOGENOUS FUNGAL ENDOPHTHALMITIS AND CHORIORETINITIS RATES, CLINICAL COURSE, AND OUTCOMES IN PATIENTS WITH FUNGEMIA. Retina. 2015 Dec 11.
- Riddell et al., Treatment of Endogenous Fungal Endophthalmitis: Focus on New Antifungal Agents. Clinc Inf Dis.
- Schmid S, Martenet AC, Oelz O. Candida endophthalmitis: clinical presentation, treatment and outcome in 23 patients. Infection 1991;19:21-4.
- Sridhar J, Flynn HW Jr, Kuriyan AE, Miller D, Albini T. Endogenous fungal endophthalmitis: risk factors, clinical features, and treatment outcomes in mold and yeast infections. J Ophthalmic Inflamm Infect. 2013 Sep 20. 3 (1):60.
- Tod M, Lortholary O, Padoin, Chaine G. Intravitreous penetration of fluconazole during endophthalmitis. Clin Microbiol Infect 1997;3:379A.
- Walsh TJ, Foulds G, Pizzo PA. Pharmacokinetics and tissue penetration of fluconazole in rabbits. Antimicrob Agents Chemother 1989;33:467-9.
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