A CASE OF MULTI-FUNGAL CHORIORETINITIS PROGRESSING TO ENDOPHTHALMITIS ; AND SUBSEQUENT NEO-VASCULAR COMPLICATIONS

Title A CASE OF MULTI-FUNGAL CHORIORETINITIS PROGRESSING TO ENDOPHTHALMITIS ; AND SUBSEQUENT NEO-VASCULAR COMPLICATIONS
Author, Co-Author Julian Vermund
Topic
Year
2013
Day
Program Number
R02013196
Room
Room 6C
Affiliation
Abstract BACKGROUND:
We present a case of endophthalmitis stemming from endogenous Candida & Aspergillus chorioretinitis. We discuss differential diagnosis, cultures, treatments, neo-vascular complications, and outcomes.

CASE REPORT(S):
I. Case History: 50 yr old, white male, “A fuzzy spot” OS, Ocular History, Glaucoma suspect, Amblyopia OD
Medical History: High WBC count, Anemia, Chronic hepatitis C, Irritable bowel syndrome, GERD, Diffuse esophageal spasm & stricture, Long esophageal myotomy, Feeding jejunostormy tube (J Tube), Portacath insertion, Ocular and Systemic Meds: non-contributory
II. Pertinent Findings, First Visit
20/25-2 OD, 20/20- OS
Anterior Segment: WNL OU
DFE: WNL OD; Flat yellow lesion in posterior pole OS
OCT indicates sub-RPE deposit
Second Visit (6 weeks later)
Emergency pain, photophobia, blur OS
20/25-2 OD, 20/400 OS
Posterior Segment:
Vitreous cells OD << OS
1/4 disk diameter deep white lesion OD
Vitreous cells obscured the retina OS
Concern for fungal endophthalmitis OS; early signs of infection OD
Cultures, treatments, consults initiated
At one of many F/U visit (3 months after treatment)
OD: 20/30 OS: HM/CF
Elevated macular CNVM by FA, treatment initiated
Cultures/Labs
(-) Gram Stain
(-) Bacterial C&S
(-) Anaerobic Culture
(+) Fungal Culture
(+) Aspergillus Fumigatus
(+) Candida Lusitaniae
III. Differential Diagnosis
Primary: multi-fungal endogenous chorioretinitis & endophthalmitis
Ocular melanoma
Aspergillus
Atypical mycobacterium
Candida
Cat scratch
Chronic granulomatous CMV
HSV
Histoplasmosis
HIV
JIA
Lyme
Metastatic lesions
HZV
White dot syndromes

CONCLUSIONS:
IV. Diagnosis & Discussion
Literature abounds with cases of endogenous fungal endophthalmitis, Multi-fungal exogenous endophthalmitis is exceedingly rare.
V Treatment, management
Intravitreal Amphotericin B, Pred Forte, Cyclopentolate
IV Amphotericin B, IV Voriconazole, Oral Fluconazole
Will discuss numerous treatment studies
Key characteristics point to endogenous fungal endophthalmitis, early recognition allows for rapid specific treatment to preserve vision.
Affiliation of Co-Authors
Outline