Scedosporium apiospermum endopthalmitis treated early with intravitreous voriconazole results in recovery of vision

Abstract

AimThe purpose of this study is to report a case of endogenous endopthalmitis caused by Scedosporium apiospermum with a favorable outcome and review previously reported cases, their treatment regimens and outcomes.MethodsAn 83-year-old man with diabetes mellitus, no other immunocompromising risk factors, and a history of S. apiospermum endopthalmitis in the left eye developed endopthalmitis in the right eye. Within 72 h of presentation, he was treated with a pars plana vitrectomy and intravitreal voriconozole.ResultsVitreous cultures confirmed S. apiospermum. The patient responded to treatment, with a favorable outcome and full recovery of vision.ConclusionsRecognition of S. apiospermum endopthalmitis and appropriate early intervention with pars plana vitrectomy and intravitreal voriconozole can lead to a favorable outcome with restoration of visual acuity.

Scedosporium apiospermum infectious scleritis following posterior subtenon triamcinolone acetonide injection: a case report and literature review

“…The treatment of infectious scleritis caused by filamentous fungi is challenging due to the difficulty of species identification and performing an antifungal drug susceptibility test, the small number of available antifungal agents, the poor drug delivery to the deep sclera, and the persistence of filamentous fungi. Additionally, scleral infections can cause the development of endophthalmitis due to direct invasion into the eyeball, thereby requiring enucleation [ 23 , 24 ]. The early detection of the causative pathogen, Scedosporium apiospermum during the early stages in the current case made it possible to successfully treat the patient and save his vision.…”

Scedosporium apiospermum contact lens-related keratitis: A rare case report and a literature review

“…Broad-spectrum ocular infections with a variable prognosis caused by SA have been reported in the literature [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]; these infections involve the eyelids [19] up to the orbital apex [17]. It can affect both immunocompetent [19, 20, 23-26, 28, 30, 32] and immunocompromised [17,18,21,22,27,29,31,[33][34][35] hosts.…”

“…Broad-spectrum ocular infections with a variable prognosis caused by SA have been reported in the literature [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]; these infections involve the eyelids [19] up to the orbital apex [17]. It can affect both immunocompetent [19, 20, 23-26, 28, 30, 32] and immunocompromised [17,18,21,22,27,29,31,[33][34][35] hosts. Following previous studies on eye infections related to SA, it appears remarkable that most cases require penetrating keratoplasty to restore at least the anatomical structure of the eye [16,20,23,26,28,30].…”

“…The most severe cases involve a history of conditions that lead to immunodeficiency, allowing a faster and more destructive intraocular growth of SA [17,21,22,27,34,35]. The pharmacological treatment of this infection includes mainly VRCZ, followed by amphotericin B, whereas surgical treatment involves penetrating keratoplasty or more aggressive techniques, such as enucleation/evisceration [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Table 1 summarizes the studies on patients' demographics, treatment approaches, and the outcomes of ocular infections caused by SA.…”

“…However, a few cases of SA-induced keratitis that were successfully treated with medical treatment alone have been reported [ 24 , 29 , 32 , 33 ]. Even in an old immunodeficient patient with a severe ocular condition, such as endophthalmitis, early diagnosis, along with prompt and proper management, could result in a good prognosis [ 31 ].…”