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Rare case of exogenous Candida dubliniensis endophthalmitis: a case report and brief review of the literature.

McMillan BD, Miller GJ, Nguyen J - J Ophthalmic Inflamm Infect (2014)

Bottom Line: He was found to have light perception vision with non-granulomatous anterior uveitis but no sign of ruptured globe.Diagnostic vitrectomy revealed purulent vitreal debris, retinal detachment with severe retinal necrosis, and choroidal infiltrates.Operative fungal cultures grew C. dubliniensis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ophthalmology, West Virginia University, 1 Stadium Dr, PO Box 9193, Morgantown, WV 26506-9193, USA.

ABSTRACT

Background: Candida dubliniensis is a recently described opportunistic fungal pathogen that rarely infects the eye. Reported cases of C. dubliniensis endophthalmitis have been of endogenous etiology and demonstrated recovery of visual acuity with timely treatment. We herein report an unusual case of severe C. dubliniensis endophthalmitis requiring enucleation.

Findings: This is a retrospective, descriptive case report with a brief literature review. A 41-year-old Caucasian man, with a history of blunt trauma 8 months prior, presented to the emergency department with left eye pain and loss of vision 2 days after complicated cataract surgery. He was first evaluated by an outside ophthalmologist 3 months after trauma for left eye pain and progressive vision loss. He was found to have light perception vision with non-granulomatous anterior uveitis but no sign of ruptured globe. A dense cataract developed while he was treated with topical and subtenon's corticosteroids for which he underwent cataract surgery. Our examination revealed no light perception vision with a relative afferent pupillary defect, elevated intraocular pressure, moderate anterior chamber reaction, pupillary membrane, vitritis, and choroidal thickening on B-scan ultrasonography. Diagnostic vitrectomy revealed purulent vitreal debris, retinal detachment with severe retinal necrosis, and choroidal infiltrates. Operative fungal cultures grew C. dubliniensis. Despite intravitreal and systemic anti-fungal treatment, vision and pain did not improve, resulting in subsequent enucleation.

Conclusion: C. dubliniensis endophthalmitis is uncommonly encountered and typically has reasonable visual outcomes. This is the first reported case of C. dubliniensis, likely exogenous endophthalmitis, resulting in enucleation, illustrating the potential virulence of this newly described organism.

No MeSH data available.


Related in: MedlinePlus

GMS stain illustrating hyphal elements.
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Figure 1: GMS stain illustrating hyphal elements.

Mentions: B-scan ultrasonography of the left eye revealed diffuse vitritis and choroidal thickening. No retinal detachment was seen. The patient was admitted to the hospital for anterior chamber washout with removal of pupillary membrane, diagnostic vitrectomy, and intravitreal injection of vancomycin (1 mg/0.1 ml), ceftazidime (2.5 mg/0.1 ml), dexamethasone (0.4 mg/0.1 ml), and amphotericin B (0.4 mg/0.1 ml). Intraoperative findings included significant fibrin anterior chamber reaction, purulent material filling the vitreous cavity, funnel retinal detachment, and multiple choroidal infiltrates. Retinal detachment repair was not attempted due to the poor status of the retinal tissue. Initial gram stain revealed several polymorphonuclear cells with rare budding yeast and very rare pseudohyphae. Fungal culture subsequently revealed C. dubliniensis sensitive to amphotericin, caspofungin, and fluconazole (FigureĀ 1). Serologic work-up for infection and inflammation included blood culture, rapid plasma reagin, fluorescent treponemal antibody-absorption, tuberculosis quantiferon gold, chest X-ray, angiotensin-converting enzyme, tick-borne disease panel, sedimentation rate, C-reactive protein, and human leukocyte antigen B27 which all were within normal limits.


Rare case of exogenous Candida dubliniensis endophthalmitis: a case report and brief review of the literature.

McMillan BD, Miller GJ, Nguyen J - J Ophthalmic Inflamm Infect (2014)

GMS stain illustrating hyphal elements.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016732&req=5

Figure 1: GMS stain illustrating hyphal elements.
Mentions: B-scan ultrasonography of the left eye revealed diffuse vitritis and choroidal thickening. No retinal detachment was seen. The patient was admitted to the hospital for anterior chamber washout with removal of pupillary membrane, diagnostic vitrectomy, and intravitreal injection of vancomycin (1 mg/0.1 ml), ceftazidime (2.5 mg/0.1 ml), dexamethasone (0.4 mg/0.1 ml), and amphotericin B (0.4 mg/0.1 ml). Intraoperative findings included significant fibrin anterior chamber reaction, purulent material filling the vitreous cavity, funnel retinal detachment, and multiple choroidal infiltrates. Retinal detachment repair was not attempted due to the poor status of the retinal tissue. Initial gram stain revealed several polymorphonuclear cells with rare budding yeast and very rare pseudohyphae. Fungal culture subsequently revealed C. dubliniensis sensitive to amphotericin, caspofungin, and fluconazole (FigureĀ 1). Serologic work-up for infection and inflammation included blood culture, rapid plasma reagin, fluorescent treponemal antibody-absorption, tuberculosis quantiferon gold, chest X-ray, angiotensin-converting enzyme, tick-borne disease panel, sedimentation rate, C-reactive protein, and human leukocyte antigen B27 which all were within normal limits.

Bottom Line: He was found to have light perception vision with non-granulomatous anterior uveitis but no sign of ruptured globe.Diagnostic vitrectomy revealed purulent vitreal debris, retinal detachment with severe retinal necrosis, and choroidal infiltrates.Operative fungal cultures grew C. dubliniensis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ophthalmology, West Virginia University, 1 Stadium Dr, PO Box 9193, Morgantown, WV 26506-9193, USA.

ABSTRACT

Background: Candida dubliniensis is a recently described opportunistic fungal pathogen that rarely infects the eye. Reported cases of C. dubliniensis endophthalmitis have been of endogenous etiology and demonstrated recovery of visual acuity with timely treatment. We herein report an unusual case of severe C. dubliniensis endophthalmitis requiring enucleation.

Findings: This is a retrospective, descriptive case report with a brief literature review. A 41-year-old Caucasian man, with a history of blunt trauma 8 months prior, presented to the emergency department with left eye pain and loss of vision 2 days after complicated cataract surgery. He was first evaluated by an outside ophthalmologist 3 months after trauma for left eye pain and progressive vision loss. He was found to have light perception vision with non-granulomatous anterior uveitis but no sign of ruptured globe. A dense cataract developed while he was treated with topical and subtenon's corticosteroids for which he underwent cataract surgery. Our examination revealed no light perception vision with a relative afferent pupillary defect, elevated intraocular pressure, moderate anterior chamber reaction, pupillary membrane, vitritis, and choroidal thickening on B-scan ultrasonography. Diagnostic vitrectomy revealed purulent vitreal debris, retinal detachment with severe retinal necrosis, and choroidal infiltrates. Operative fungal cultures grew C. dubliniensis. Despite intravitreal and systemic anti-fungal treatment, vision and pain did not improve, resulting in subsequent enucleation.

Conclusion: C. dubliniensis endophthalmitis is uncommonly encountered and typically has reasonable visual outcomes. This is the first reported case of C. dubliniensis, likely exogenous endophthalmitis, resulting in enucleation, illustrating the potential virulence of this newly described organism.

No MeSH data available.


Related in: MedlinePlus