Fungal endophthalmitis: an unusual complication of GI surgery and endoluminal vacuum therapy

Abstract

SUMMARYWe present a case of endogenous fungal endophthalmitis arising as a complication of fungal septicaemia following gastrointestinal surgery, and subsequent treatment with endoluminal vacuum therapy (Endo-SPONGE, B Braun Medical Ltd). Our patient developed a pre-sacral collection due to an anastomotic leak post ileoanal pouch formation. Despite treatment with Endo-sponges and antibiotics, the patient suffered recurrent sepsis and the cavity failed to reduce in size. He developed red eyes and blurred vision, leading to the diagnosis of fungal endophthalmitis. Extended fungal cultures of the Endo-sponges and pouch effluent revealed Candida spp. This case is the first report of fungal endophthalmitis associated with Endo-sponge use and highlights the importance of fungal cultures in patients with ongoing sepsis. BACKGROUND

Endogenous endophthalmitis by <i>Candida glabrata</i>: An unusual complication of digestive surgery

“…reported a case of EFE arising as a complication of fungal septicemia three months following gastrointestinal surgery, and subsequent treatment with endoluminal vacuum therapy [4]. In this case, the patient was treated with multiple courses of intravenous antibiotics and blood culture was positive to Candida albicans [4]. In our case, diagnosis of EFE was difficult because we had not clinical data in favor of candidiasis and blood culture were negative.…”

“…We found only one case report of EFE following digestive surgery in our literature review: Megan Wood and al. reported a case of EFE arising as a complication of fungal septicemia three months following gastrointestinal surgery, and subsequent treatment with endoluminal vacuum therapy [4]. In this case, the patient was treated with multiple courses of intravenous antibiotics and blood culture was positive to Candida albicans [4].…”

“…In our case, a history of immunosuppressant use and recent digestive surgery was noted. In fact, ocular complications in colorectal surgery are rare [4] and the risk of a hospitalized patient developing endophthalmitis from fungemia appears to be low overall. However, immunodepression and digestive surgical is described among the risk factors of EFE [5].…”

Postoperative Late-Onset Endophthalmitis Caused by <b><i>Leishmania donovani</i></b>: A Case Report

“…Even though a lot of preoperative, intraoperative, as well as postoperative measures are being taken every day in order to avoid it, endophthalmitis still occurs mostly in an acute form [1]. When it comes to late-onset endophthalmitis, it can be seen after gastrointestinal [2] and pacemaker surgeries [3]. Some authors even report an orbital involvement of post-cataract-glaucoma surgery endophthalmitis [4].…”