Dematiaceous fungal endophthalmitis: report of a case and review of the literature

Abstract

Background Pleurostomophora richardsiae (formerly Phialophora richardsiae) is a dematiaceous fungus that is an uncommon cause of ocular infection. Herein, we present a case of endogenous endophthalmitis associated with disseminated P. richardsiae infection.FindingsThis is a descriptive case report with a brief review of literature. A 43-year-old male admitted to the hospital following an acute cerebellar hemorrhage was found to have a swollen and tender wrist. The patient was afebrile with leukocytosis. Visual acuity was hand motion in the right eye and 20/20 in the left. Right eye examination noted anterior chamber cells and flare, vitreous haze and multiple large, and fluffy retinal infiltrates. Diagnostic vitrectomy revealed a mixed inflammatory cell infiltrate with numerous fungal elements. Blood cultures were negative, multiple transesophageal echocardiography studies revealed no vegetations, and synovial fluid aspiration of the wrist and biopsy of the radius were unremarkable. The patient was treated with intravitreal cefazolin, vancomycin, and amphotericin B, topical ciprofloxacin and natamycin, and intravenous amphotericin B and voriconazole. Visual acuity in the right eye declined to light perception, and examination revealed increasing anterior and posterior chamber inflammation. The patient died several weeks after presentation due to a massive intracranial hemorrhage. Fungal culture results from the vitrectomy were received post mortem and were positive for P. richardsiae.Conclusions P. richardsiae endophthalmitis is rare, and outcomes are typically poor. Infections typically occur following traumatic skin inoculation; however, a long refractory period may occur before symptoms develop. Early diagnosis and combination antimicrobial therapy are essential to optimize visual outcomes.

Disseminated phaeohyphomycosis with hepatic artery and portal vein thrombosis caused by Pleurostomophora richardsiae in a liver transplant recipient: A case report

“…As a wood decay fungus that is found in soil, most P richardsiae infections are caused by traumatic inoculation. Many patients may not recognize the association between the traumatic event and the infection, because of the lengthy incubation period . Cases of chromoblastomycosis typically presented with subcutaneous verrucous, ulcerated, or crusted lesions and eumycotic mycetoma, which are tumor‐like lesions with draining sinus tracts and fungal grains that are caused by P richardsiae .…”

“…Subcutaneous P richardsiae infections can occur in healthy people and in people with immunocompromised conditions, such as those having diabetes mellitus, having post‐transplantation status, taking immunosuppression therapy, or taking chemotherapy . Invasive infections caused by P richardsiae were usually observed in immunocompromised patients (Table ) . In our case, the fungi may have been donor‐derived or it may have been inoculated into the infected site during the operation for the following reasons.…”

“…To date, no guideline has been established regarding the appropriate antifungal to treat P richardsiae infection. However, almost all reported cases were treated with amphotericin B alone or in combination with second agents (eg, flucytosine or voriconazole) as induction therapy . The outcomes of patients with invasive P richardsiae depended on the type and number of organ involvement, on host factors, and on the adequacy of surgical debridement.…”

“…Dematiaceous molds are fungi that have dark hyphae that are caused by the deposition of dihydroxynaphthalene melanin in their cell walls . Common genera of dematiaceous molds that cause opportunistic infection in humans include Alternaria , Bipolaris , Curvularia , Cladophialophora , Exophiala , and Phaeoacremonium . Pleurostomophora richardsiae , a genus of dematiaceous mold that was formerly known as Phialophora richardsiae , is found in soil, decaying wood, and vegetation—especially in tropical climates .…”

“…Normally, Pleurostomophora richardsiae is a wood decay fungus that only rarely causes diseases in humans . Most reported cases of P richardsiae infection in humans were subcutaneous cystic phaeohyphomycosis . There are only a few reported cases of invasive or disseminated P richardsiae infection.…”