Endogenous Candida Endophthalmitis with Bilateral Massive Submacular Abscess

Abstract

Purpose: We present a case of endogenous endophthalmitis in which the patient presented with an overall clinical picture suggestive of bacterial endophthalmitis but was subsequently found to have Candida endophthalmitis. Case summary: A 50-year-old man with hepatic encephalopathy and alcoholic liver cirrhosis who was treated in gastroenterology presented with reduced vision in both eyes. Indirect ophthalmoscopy showed bilateral massive submacular abscesses and surrounding retinal hemorrhage. In view of the initial fundal picture of a submacular abscess lesion, the subacute course of the disease, and a medical history of diabetes and liver cirrhosis, a provisional diagnosis of bacterial endophthalmitis was made. Treatment with topical and systemic empirical antibiotics was immediately initiated. Despite the treatment, the patient's condition worsened, and the patient underwent diagnostic and therapeutic vitrectomy. Vitreous cultures revealed the growth of Candida albicans. With a diagnosis of endogenous candida endophthalmitis, he was treated with intravitreous amphotericin B and intravenous fluconazol. Conclusions: Candida albicans should be considered in the differential diagnosis of endogenous endophthalmitis when massive submacular abscesses and hemorrhage are seen.