Exophiala dermatitidis Endophthalmitis: Case Report and Literature Review

Abstract

We report a case of a 59-year-old male patient with a postoperative fungal infection of the left eye. A dark-pigmented yeast, Exophiala dermatitidis (previously known as Wangiella dermatitidis), was identified from the culture of the biopsy taken from the posterior capsule. The infection was successfully eradicated by a combination of surgical and medical (i.e., voriconazole and fluconazole) treatment. This is the first report of successfully treated E. dermatitidis endophthalmitis, which demonstrates that a prompt and aggressive antifungal therapy combined with surgical intervention is necessary to prevent vision loss in cases of endophthalmitis due to Exophiala species. Beside the case description, we also aim to provide a literature review of previously reported eye infections caused by Exophiala species in order to help the future diagnosis and management of the disease.

Orbital abscess caused by Exophiala dermatitidis following posterior subtenon injection of triamcinolone acetonide: a case report and a review of literature related to Exophiala eye infections

“…There is no tendency for certain species of Exophiala to have a higher affinity towards certain parts of the eye. However, E. jeanselmei and E. dermatitidis have higher affinities to the human eye than the other species do [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Interestingly, in the past 5 years, E. phaeomuriformis has been reported as a causative strain of eye infections.…”

“…Interestingly, as listed in Table 3 , most of the reported cases of eye infection caused by Exophiala had a history of certain surgical interventions [ 3 , 4 , 6 – 8 ], which may have caused trauma to human tissues. E. dermatitidis can be isolated from environments where human impact is present, similarly to S. apiospermum [ 33 ].…”

“…Of the eye infections caused by the Exophiala species, we found 19 case reports in the English literature, which identified the species of the causative strains. At present, four species, namely E. dermatitidis, E. jeanselmei, E. phaeomuriformis, and E. werneckii, have been reported to be the causative species of eye infections [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

Exophiala Keratitis following Descemet Stripping Automated Endothelial Keratoplasty

“…Exophiala xenobiotica is a segregant of the Exophiala jeanselmei complex, frequently found in habitats rich in monoaromatic hydrocarbons and alkanes [ 2 ]. Eye infections due to Exophiala s pecies are extremely rare but have been reported [ 3 ].…”

Peritonitis by Exophiala dermatitidis in a pediatric patient

“…Phaeohyphomycosis covers a heterogeneous group of mycotic infections caused by dematiaceous fungi and characterized by the presence of melanized hyphal elements, yeast-like cells, or a combination of these in the host tissue. According to the extent and depth of invasion, the disease is classified as superficial, subcutaneous, systemic and cerebral [1]. Among the more important human pathogens are species of the genera of the order Chaetothyriales (black yeasts and relatives), such as Cladophialophora , Exophiala , Fonsecaea , Phialophora [1,2].…”