A case of aspergillus endophthalmitis in an immuncompetent woman: intra-ocular penetration of oral voriconazole: a case report

Abstract

BackgroundThere are very few reports of Aspergillus fumigatus causing endogenous endophthalmitis (EAE) in immunocompetent individuals although it is well recognised in the immunocompromised. Treatment can be with intravitreal, intravenous and oral antifungal agents. The benefit of an oral agent is clear however the concentration of voriconazole in the inflamed eye after oral administration has not previously been documented.Case presentationWe present a case of EAE in an immunocompetent 78-year-old Caucasian female who was subsequently managed with oral voriconazole. Using a bioassay, we show an appropriate voriconazole concentration in serum and vitreous samples.ConclusionThis case adds to the limited literature on the prevalence of endogenous endophthalmitis in immunocompetent patients and supports the use of voriconazole in such cases.

Endogenous filamentous fungal endophthalmitis - single-centre survey in patients with acute leukaemia or postallogeneic stem cell transplantation and review of the literature

“…A total of 56 patients with endogenous endophthalmitis caused by filamentous fungi were identified from case reports, small case series and the larger case series published by Lamaris and others 8,10–34 . In the majority of patients, the infecting fungus was Aspergillus (29 patients) followed by Scedosporium species (14 patients), Fusarium species (nine patients) and other rare fungi (four patients; Table 3).…”

Endogenous endophthalmitis: diagnosis, management, and prognosis

“…Voriconazole is a newer agent in the armory of drugs used to treat ocular fungal infections. It achieves an excellent intravitreal concentration after oral or intravenous administration [ 36 ]. The usual dose of voriconazole is 100–200 mcg in 0.1 ml sterile water.…”

Infección ocular invasora por Scedosporium apioespermum en un paciente inmunocomprometido

“…En nuestra paciente, afectada progresivamente con conjuntivitis, escleritis y finalmente con una panuveitis complicada con desprendimiento de la coroides, se aplicó un enfoque médico-quirúrgico con desbridamientos quirúrgicos y terapia prolongada con voriconazol con niveles plasmáticos adecuados. La concentración con la administración oral de voriconazol alcanza un valor aproximado de 1-1,5 µg/ml en el humor acuoso y de 0,8-1,1 µg/ml en el humor vítreo y posiblemente sean equivalentes a las del plasma en casos de inflamación ocular (2-3 µg/ml) lo que permite alcanzar un efecto inhibitorio local 22,23 . La terapia tópica con voriconazol complementa el tratamiento, logrando concentraciones > 1 µg/ml en la cámara anterior si las gotas son aplicadas en forma frecuente (cada hora) 24 .…”