Posttraumatic Aspergillus terreus endophthalmitis masquerading as dispersed lens fragments

Abstract

A 20-year-old man developed increasing inflammation with a hypopyon 3 weeks after primary repair of a corneal laceration. An occult anterior capsule puncture was suspected as the stimulus for the inflammation. When aspiration of the suspected hydrated lens material was not curative, a vitrectomy with injection of intravitreal antibiotic agents including amphotericin (0.0125 mg) was done the following day; the culture failed to grow fungal organisms. A repeat vitrectomy was performed 1 week later, and the culture grew Aspergillus terreus. This was determined to be resistant to amphotericin so voriconazole was injected intravitreally. The inflammation recurred, and the eye required enucleation because of blindness and intractable pain. Fungal endophthalmitis should be considered in cases of delayed-onset inflammation after trauma and may be due to organisms resistant to amphotericin.

Fusarium endophthalmitis following refractive lens exchange for correction of high myopia

“…A recent publication has demonstrated the case of a posttraumatic Aspergillus terreus endophthalmitis, which mimicked dispersed lens fragments. 16 In our patient, the suspected lens fragment in the posterior chamber may have been culture-negative Fusarium ssp since growth of Fusarium ssp in culture was proven after repeated vitrectomy.…”

Aspergillus terreus endogenous endophthalmitis: Report of a case and review of literature

“…Three cases of postoperative and 1 case of posttraumatic endophthalmitis have been reported. [ 7 8 9 ] Riddell et al .,[ 10 ] have reported the ocular manifestations of endogenous Aspergillus endophthalmitis. Patients present with sudden painful unilateral blurring of vision, variable amount of circumciliary congestion, AC reaction and hypopyon.…”

Detection of Candida and Aspergillus species DNA using broad-range real-time PCR for fungal endophthalmitis

“…Our specific aims were to try and significantly increase the number of intraocular samples from which a confirmed diagnosis could be made and to reduce the time it took to make a mycologic diagnosis. In many previous reports, DNAs of Candida and Aspergillus species were detected in patients with clinically suspected fungal endophthalmitis [7][8][9][10][15][16][17][18][19][20]. For example, Candida species such as C. albicans, C. parapsilosis, C. tropicalis, C. guilliermondii, C. glabrata, and C. krusei have been increasingly recognized as being capable of causing fungal endophthalmitis.…”

“…However, C. albicans has been shown to be the causative agent in the majority of cases of culture-proven endophthalmitis. Moreover, Aspergillus such as A. fumigatus, A. flavus, A. nidulans, A. niger, and A. terreus have also been reported to be the causative species in an unknown ocular infection [17][18][19][20]. To detect these fungal species, our present PCR system used paired primers and specific probes that were based upon the 18S rRNA genes of Candida and Aspergillus (see Fig.…”